TY - JOUR
T1 - Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants
T2 - a secondary analysis of the NECTARINE cohort☆
AU - NECTARINE Steering Committee
AU - Fuchs, Alexander
AU - Disma, Nicola
AU - Engelhardt, Thomas
AU - Marchesini, Vanessa
AU - Riedel, Thomas
AU - Boda, Krisztina
AU - Habre, Walid
AU - Riva, Thomas
AU - Disma, Nicola
AU - Veyckemans, Francis
AU - Virag, Katalin
AU - Hansen, Tom G.
AU - Becke-Jakob, Karin
AU - Harlet, Pierre
AU - Vutskits, Laszlo
AU - Walker, Suellen M.
AU - de Graaff, Jurgen C.
AU - Zielinska, Marzena
AU - Simic, Dusica
AU - Engelhardt, Thomas
AU - Habre, Walid
AU - Breschan, Christian
AU - Likar, Rudolf
AU - Platzer, Manuela
AU - Edelman, Isole
AU - Eger, Johanes
AU - Heschl, Stefan
AU - Messerer, Brigitte
AU - Vittinghof, Maria
AU - Kroess, Ruth
AU - Stichlberger, Martina
AU - Kahn, David
AU - Pirotte, Thierry
AU - Pregardien, Caroline
AU - Veyckemans, Francis
AU - Stevens, France
AU - Berghmans, Johan
AU - Bauters, Annemie
AU - De Baerdemaeker, Luc
AU - De Hert, Stefan
AU - Lapage, Koen
AU - Parashchanka, Aliaksandra
AU - Van Limmen, Jurgen
AU - Wyffels, Piet
AU - Lauweryns, Julie
AU - Absalom, Anthony R.
AU - Meier, Sascha
AU - Volkers, Martin
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/11
Y1 - 2025/11
N2 - Background: Optimal ventilation strategies and use of neuromuscular blocking agents (NMBAs) in neonates and small infants undergoing anaesthesia remain unclear. We examined the association of perioperative ventilation strategies and administration of NMBAs on respiratory adverse events in the NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) cohort. Methods: We performed a secondary analysis of NECTARINE, which included infants up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures. The primary endpoint was the association between ventilation mode and intraoperative respiratory adverse events. Secondary endpoints were use of NMBA, and 30-day postoperative pulmonary complications (PPCs). Results: The dataset comprised 5609 patients undergoing 6542 procedures. Pressure-controlled ventilation was the primary ventilation modality, accounting for 52.4% (n=3428) of cases. The incidence of intraoperative respiratory critical events was 20.7% (95% confidence interval [CI] 19.7–21.7%), while PPCs were observed in 17% of cases (95% CI 16.0–18.1%). Preanaesthesia respiratory conditions and NMBA use after tracheal intubation were associated with higher incidence of PPCs. Of the children receiving NMBAs, reversal was reported in 29.8%. The absence of reversal was associated with a higher incidence of PPCs, with a relative risk of 1.50 (95% CI 1.17–1.93). Conversely, NMBA reversal was associated with a reduced relative risk of 0.43 (95% CI 0.26–0.70). Conclusions: Regardless of ventilation strategy used, mechanical ventilation and baseline respiratory conditions were risk factors for a greater incidence of adverse respiratory events and PPCs. Reversal of NMBAs before tracheal extubation was significantly associated with reduced PPCs in neonates and should be routine clinical practice. Clinical trial registration: ClinicalTrials.gov (NCT02350348).
AB - Background: Optimal ventilation strategies and use of neuromuscular blocking agents (NMBAs) in neonates and small infants undergoing anaesthesia remain unclear. We examined the association of perioperative ventilation strategies and administration of NMBAs on respiratory adverse events in the NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) cohort. Methods: We performed a secondary analysis of NECTARINE, which included infants up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures. The primary endpoint was the association between ventilation mode and intraoperative respiratory adverse events. Secondary endpoints were use of NMBA, and 30-day postoperative pulmonary complications (PPCs). Results: The dataset comprised 5609 patients undergoing 6542 procedures. Pressure-controlled ventilation was the primary ventilation modality, accounting for 52.4% (n=3428) of cases. The incidence of intraoperative respiratory critical events was 20.7% (95% confidence interval [CI] 19.7–21.7%), while PPCs were observed in 17% of cases (95% CI 16.0–18.1%). Preanaesthesia respiratory conditions and NMBA use after tracheal intubation were associated with higher incidence of PPCs. Of the children receiving NMBAs, reversal was reported in 29.8%. The absence of reversal was associated with a higher incidence of PPCs, with a relative risk of 1.50 (95% CI 1.17–1.93). Conversely, NMBA reversal was associated with a reduced relative risk of 0.43 (95% CI 0.26–0.70). Conclusions: Regardless of ventilation strategy used, mechanical ventilation and baseline respiratory conditions were risk factors for a greater incidence of adverse respiratory events and PPCs. Reversal of NMBAs before tracheal extubation was significantly associated with reduced PPCs in neonates and should be routine clinical practice. Clinical trial registration: ClinicalTrials.gov (NCT02350348).
KW - intraoperative respiration
KW - mechanical ventilation
KW - neonate
KW - neuromuscular blocking agent
KW - paediatric
KW - postoperative pulmonary complications
KW - respiratory adverse events
UR - https://www.scopus.com/pages/publications/85218167946
U2 - 10.1016/j.bja.2024.12.038
DO - 10.1016/j.bja.2024.12.038
M3 - Article
AN - SCOPUS:85218167946
SN - 0007-0912
VL - 135
SP - 1528
EP - 1536
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 5
ER -