Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants: a secondary analysis of the NECTARINE cohort☆
Publication date
2025-11
Authors
Fuchs, Alexander
Disma, Nicola
Engelhardt, Thomas
Marchesini, Vanessa
Riedel, Thomas
Boda, Krisztina
Habre, Walid
Riva, Thomas
Disma, Nicola
Veyckemans, Francis
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Document Type
Article
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Abstract
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).
Keywords
intraoperative respiration, mechanical ventilation, neonate, neuromuscular blocking agent, paediatric, postoperative pulmonary complications, respiratory adverse events, Anesthesiology and Pain Medicine
Citation
Fuchs, A, Disma, N, Engelhardt, T, Marchesini, V, Riedel, T, Boda, K, Habre, W, Riva, T, Disma, N, Veyckemans, F, Virag, K, Hansen, T G, Becke-Jakob, K, Harlet, P, Vutskits, L, Walker, S M, de Graaff, J C, Zielinska, M, Simic, D, Engelhardt, T, Habre, W, Breschan, C, Likar, R, Platzer, M, Edelman, I, Eger, J, Heschl, S, Messerer, B, Vittinghof, M, Kroess, R, Stichlberger, M, Kahn, D, Pirotte, T, Pregardien, C, Veyckemans, F, Stevens, F, Berghmans, J, Bauters, A, De Baerdemaeker, L, De Hert, S, Lapage, K, Parashchanka, A, Van Limmen, J, Wyffels, P, Lauweryns, J, Buhre, W, Hendriks, M, Pieters, B, Van Zaane, B & NECTARINE Group of the European Society of Anaesthesiology and Intensive Care Clinical Trial Network 2025, 'Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants : a secondary analysis of the NECTARINE cohort ☆', British Journal of Anaesthesia, vol. 135, no. 5, pp. 1528-1536. https://doi.org/10.1016/j.bja.2024.12.038