Factors Contributing to Endobronchial Intubation in Neonates*

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Abstract
To assess neonatologists' practices, knowledge, and opinions regarding the prevention of endobronchial intubation. Anonymous survey. Program Directors of Neonatology Fellowship Programs in the United States, surveyed by mail, and neonatologists who volunteered to respond while attending the Vermont-Oxford Network Annual Meeting. None. Program directors (response rate 66%) and other practitioners contributed equally to the 132 survey responses, which were statistically indistinguishable between groups. Deep intubation frequency was estimated at greater than 5% by 39% of respondents, and 38% believed that it contributes to neonatal morbidity equally or more than medication errors. Quality assurance surveillance of intubations was uncommon. Neonatologists had remarkably varied responses when identifying the recommended vocal cord-level marking from a triple set of distal safety markings on a commonly used endotracheal tube; most had never seen recommendations or package insert directions for the use of such markings, and 86% desired improvements in endotracheal tube features to promote safer intubations. Neonatologists perceive endobronchial intubation as a consequential but underreported complication. Most are uncertain about the use of common vocal cord markings on endotracheal tubes, and few have seen specific instructions on this feature. We suggest that standardizing endotracheal tube safety features and making clear directions available to users may decrease the risk of endobronchial intubation in neonates.

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