16+ tricks for a successful NEONATAL endotracheal intubation!!!

A CHECK-LIST of items to consider when you're having a TOUGH time with a baby's intubation! How is the ETT inserted? How do you position yourself for an intubation? And the baby? What if the cords are super anterior? Do you always suction? Use a stylet? How can pre-medication and HFNC help? What if the cords are closed? Is your equipment functioning? Learn our recommendations here!
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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References:
NRP textbook 8th edition
Hodgson KA, Owen LS, Kamlin COF, Roberts CT, Newman SE, Francis KL, Donath SM, Davis PG, Manley BJ. Nasal High-Flow Therapy during Neonatal Endotracheal Intubation. N Engl J Med. 2022 Apr 28;386(17):1627-1637. doi: 10.1056/NEJMoa2116735. PMID: 35476651.
Kumar P, Denson SE, Mancuso TJ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Premedication for nonemergency endotracheal intubation in the neonate. Pediatrics. 2010 Mar;125(3):608-15. doi: 10.1542/peds.2009-2863. Epub 2010 Feb 22. PMID: 20176672.
Steinhorn, R, De Ungria, M, Glob. libr. women's med.,(ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10203
Hatch LD, Grubb PH, Lea AS, Walsh WF, Markham MH, Maynord PO, Whitney GM, Stark AR, Ely EW. Interventions to Improve Patient Safety During Intubation in the Neonatal Intensive Care Unit. Pediatrics. 2016 Oct;138(4):e20160069. doi: 10.1542/peds.2016-0069. Epub 2016 Sep 21. PMID: 27694281; PMCID: PMC5051203.
Bensouda B, Mandel R, Mejri A, Lachapelle J, St-Hilaire M, Ali N. Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial. BMC Med Educ. 2018 Oct 3;18(1):230. doi: 10.1186/s12909-018-1338-4. PMID: 30285715; PMCID: PMC6171149.
O'Connell J, Weiner G Intubating extremely premature newborns: a randomised crossover simulation study BMJ Paediatrics Open 2017;1:e000157. doi: 10.1136/bmjpo-2017-000157
Kumar P, Denson SE, Mancuso TJ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Premedication for nonemergency endotracheal intubation in the neonate. Pediatrics. 2010 Mar;125(3):608-15. doi: 10.1542/peds.2009-2863. Epub 2010 Feb 22. PMID: 20176672.
www.mayoclinic.org/diseases-conditions/cleft-palate/symptoms-causes/syc-20370985
www.childrens.health.qld.gov.au/health-a-to-z/vocal-cord-palsy
www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/neonatology/management-of-the-difficult-airway-neonates
www.medline.com/media/mkt/pdf/Standard-Laryngoscopes-IFU.pdf
ars.els-cdn.com/content/image/1-s2.0-S0300957214007291-mmc1.jpg?sa=X&ved=2ahUKEwi70_Prkd6CAxXYlGoFHYiQC7sQ_B16BAgCEAI
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***TIMESTAMPS***
00:08 Attempt often
00:59 Find perfect view
01:57 Baby's level is ideal
02:39 Use curve of ETT
03:15 Use correct size blade
04:07 Intubate in 30 seconds
04:44 Baby is stable during attempt
05:18 Premeditate
05:48 Use readers
06:36 Try learning without a stylet
07:59 Be prepared for closed vocal cords
08:32 Be prepared for difficult intubations
09:37 Set up perfect environment
10:14 Avoid suction unless necessary
11:08 Make sure bulb is working
12:00 Do not trust pedicab blindly
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

Пікірлер: 52

  • @Kopiroti09
    @Kopiroti09Ай бұрын

    First tip makes me slightly emotional. Thank you for the words of encouragement

  • @TalaTalksNICU

    @TalaTalksNICU

    28 күн бұрын

    Not sure how I didn’t answer this!!!! We’ve all been there! You r got this!!!

  • @dougdixon4587
    @dougdixon45877 ай бұрын

    More please!! Thank you for your dedication!

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    Absolutely! Thank you so much for watching and for subscribing and being such a great supporter!

  • @ronzrt
    @ronzrt5 ай бұрын

    Thank you. Appreciate the knowledge and great tips.

  • @TalaTalksNICU

    @TalaTalksNICU

    5 ай бұрын

    Thank you so much for watching- hopefully it’s clinically helpful!

  • @user-sd5ow2lz9o
    @user-sd5ow2lz9o6 ай бұрын

    Thanks for the education that all can afford!!

  • @TalaTalksNICU

    @TalaTalksNICU

    5 ай бұрын

    Love this so much. It really is amazing the access we have now to excellent free education. I'm going to do a video on free websites etc we can use (and I do use)!

  • @PARAMEDICKSA
    @PARAMEDICKSA7 ай бұрын

    Thank you very much. I benefited and enjoyed the method of explanation, Doc👋

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    Oh great! Thanks so much for watching and for commenting :)

  • @readiop2722
    @readiop27227 ай бұрын

    These are all wonderful tips. Thanks Dr. Tala

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    Thank you so much for watching! Appreciate you taking the time to comment :)

  • @thommy_kni
    @thommy_kni6 ай бұрын

    Very helpful video and advices. Highly appreciate it. It is always the best to learn from an expert with a lot of experience. Thank you.

  • @TalaTalksNICU

    @TalaTalksNICU

    6 ай бұрын

    Oh thank you! Everyone becomes an expert when they’ve done 100s or maybe 1000s of something- right? Thank you so much for being here!

  • @m.e.2286
    @m.e.22865 ай бұрын

    Thank you, these tips are so much appreciated & encouraging

  • @TalaTalksNICU

    @TalaTalksNICU

    4 ай бұрын

    So glad you find them encouraging too! Everyone can get there!!

  • @m.e.2286

    @m.e.2286

    4 ай бұрын

    @@TalaTalksNICU 💕🙏🏼💕

  • @veenamary5442
    @veenamary54422 ай бұрын

    Amazing . Thankyou Mam.

  • @TalaTalksNICU

    @TalaTalksNICU

    2 ай бұрын

    So glad you found it helpful! Thank you for taking time to write!

  • @dr.melshehawi5711
    @dr.melshehawi5711Ай бұрын

    Thanks Dr TaLa

  • @TalaTalksNICU

    @TalaTalksNICU

    Ай бұрын

    Thank you for taking time to write )

  • @aquascapebomahdi3309
    @aquascapebomahdi330910 күн бұрын

    Great info appreciate the hard work The problem with me is when intubating small babies 0-4 months oral opening to small i can see the glottis and the vocal cords but once i thread in the ett im blind every thing is obstructed and i fail any tips how to maximize the oral view making it easier to thread the ett comfortably

  • @remabuzeid3842
    @remabuzeid38423 ай бұрын

    Very helpful tips especially with glasses as last time I couldn't see Vocal cord easily due blurring 😢

  • @TalaTalksNICU

    @TalaTalksNICU

    3 ай бұрын

    Changed my life!!!! Ha! It’s nice knowing that the issue is fixable though!!!!

  • @melishendek6472
    @melishendek64727 ай бұрын

    Thank you again. In europe we intubate generally nasal and not oral. Which advantage do have with your procedure? Yes, of course its pretty cool to have a "niv" during the intubation..

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    Hello- that's so interesting- and apparently completely cultural. I have a colleague who can do either, but apart from him, every intubation I've done or seen has been oral.

  • @neoneo-cz7zh
    @neoneo-cz7zh7 ай бұрын

    Super as usual sr Tala.please try to collect in a practical videos for intubation for more benefit . Thanks again so much

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    Hello- so sorry took so long to reply! We did another view showing the steps of intubation- is that what you were thinking? Would love some advice on what you think would be most helpful way to show in a video!!! Thanks!!!

  • @neoneo-cz7zh

    @neoneo-cz7zh

    7 ай бұрын

    @@TalaTalksNICU I know that you are too much busy to reply I mean for showing videos for neonatal intubation and to comment on it that is true and beneficial and help in intubation success and that is make intubation difficult and failed.thanks

  • @felipeguinancio7456
    @felipeguinancio74567 ай бұрын

    Very good tips Dr Tala! Great video! And wich hospital do you work. Ty a lot again.

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    Hello! thank you so much! I work in Texas in US. (We actively keep our hospital and practices out of this channel because even though they allow us to continue the channel, we are not speaking on their behalf)!!

  • @felipeguinancio7456

    @felipeguinancio7456

    7 ай бұрын

    @@TalaTalksNICU ty a lot for the feedback! Do they accept fellowship program?

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    @felipeguinancio7456 hello! No we don’t have fellows in our hospitals (that would be nice though!)

  • @felipeguinancio7456

    @felipeguinancio7456

    7 ай бұрын

    @@TalaTalksNICU so sad!

  • @docvaruna
    @docvaruna7 ай бұрын

    Younger generations don't accept the experience. They think if they know they are better than others. Well said Tala. Take care of your health. Losing too much of weight is also not good.

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    It's difficult to appreciate how important experience is when you don't have it. Either we feel- I'll never be able to do that, or the opposite- I've done this a few times, so I've got it. Experience teaches a lot but also very humbling!!! Thank you for your comment! I have been about the same weight for a long time0 just bigger scrubs! :)

  • @ceciliai.ogwude2845

    @ceciliai.ogwude2845

    4 ай бұрын

    Please don't speak for younger generations. A lot of people from YOUR generation have exactly the same problem. It's an uncomfortable situation having to learn a new skill as an adult. It comes with a lot of feelings of inadequacy. The less huge of an ego you have, the easier it is to accept you cannot know everything and cannot learn without failing. All this to say, please stop acting like this is a problem reserved for "younger generations". It's simply not true.

  • @docvaruna

    @docvaruna

    4 ай бұрын

    @ceciliai.ogwude2845 Sorry. It is not good to generalise. Thanks for bringing it.

  • @TalaTalksNICU

    @TalaTalksNICU

    4 ай бұрын

    I think something was lost in what I was saying. By NO means was I saying that my generation knows everything!!!! It is really really difficult learning a new skill and my point was that the more everyone does the better they are. Literally everyone can become proficient. It was supposed to be very encouraging- in no way disparaging anyone!!!! Literally last thing on my mind

  • @ceciliai.ogwude2845

    @ceciliai.ogwude2845

    4 ай бұрын

    @@docvaruna thank you🙏🏾

  • @rritalimaj8186
    @rritalimaj81867 ай бұрын

    Dr. Nala, I’m Rrita from Kosovo! I recently gave birth to my baby who was sent to the NICU here for meconium aspiration. My baby was also intubated, and since discharge has had feeding difficulties and a raspy voice. Can it be that incorrect intubation can damage the anatomy there and cause difficulties feeding /swallowing?

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    Hello! I love you called me Dr. Nala- my maiden name began with an N, so people called me that all the time! Congrats on your baby! I would think it would be very unlikely from the intubation- maybe that caused irritation or something at the time- but that would have resolved. I'm not sure how long he was intubated for? I hope he continues to improve XX

  • @rritalimaj8186

    @rritalimaj8186

    7 ай бұрын

    @@TalaTalksNICU oh gosh, darn autocorrect! Thank you so much for your response Dr. Tala! My daughter was intubated for 2 weeks. I wondered, because she also has a short neck, but who knows. Anyways, love your videos! I am learning so much, and I’m not even a doctor, just a graduated NICU mom!

  • @TalaTalksNICU

    @TalaTalksNICU

    7 ай бұрын

    @rritalimaj8186 ha! That’s a safe autocorrect compared to some of the howlers I’ve sent!!! I don’t know why we see feeding issues in patients who have been intubated for some time. It does seem to affect their coordination. But those speech therapists work miracles and babies do get better (especially with thicker foods)! Thanks so much for being here!

  • @sbiswas0227
    @sbiswas02273 ай бұрын

    Excellent teaching video with great tips, just do not agree about the stylet tip and the suction tip. :)-

  • @TalaTalksNICU

    @TalaTalksNICU

    3 ай бұрын

    I love that you do things a different way! Cannot emphasize enough that a lot of what we do- especially with procedures is personal opinion!!! I’m not sure if that comes through enough in our videos- this is just the way I do it- not how you need to do it! Thank you for sharing and for watching!!!

  • @sbiswas0227

    @sbiswas0227

    3 ай бұрын

    about the higher refractive index you mentioned, are you suggesting a particular no or the same one I use for reading at home. Thanks@@TalaTalksNICU

  • @TalaTalksNICU

    @TalaTalksNICU

    3 ай бұрын

    Higher than you use for reading!!! Like maybe 1 higher!! I love it!

  • @kristenb2968
    @kristenb29682 ай бұрын

    What strength of readers do you recommend for someone with 20/20 vision

  • @TalaTalksNICU

    @TalaTalksNICU

    2 ай бұрын

    I’d start with 1 or 1.5! (Obviously I’m not an ophthalmologist but would literally be using for 15 seconds or whatever takes to intubate!)

  • @kristenb2968

    @kristenb2968

    2 ай бұрын

    @@TalaTalksNICU Thank you. I will give it a try!