Evidence map›Paper›PMID 39979152›Full record

Observational studyBritish journal of anaesthesia2025

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

Alexander Fuchs, Nicola Disma, Thomas Engelhardt, Vanessa Marchesini, Thomas Riedel, Krisztina Boda, Walid Habre, Thomas Riva, NECTARINE Steering Committee, NECTARINE Group of the European Society of Anaesthesiology and Intensive Care Clinical Trial Network

Registry-linked trialAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02350348 (NECTARINE), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02350348 completednot on this map

NECTARINE: NEonate-Children sTudy of Anaesthesia pRactice IN Europe Epidemiology of Morbidity and Mortality in Neonatal Anaesthesia: A European Prospective Multicentre Observational Study

TypeobservationalSponsorEuropean Society of AnaesthesiologyRan2016 to 2019Enrolled5,500ConditionsChildren, Anaesthesia
3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Alexander FuchsDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: alexander.fuchs@insel.ch.
Nicola DismaUnit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Thomas EngelhardtQueen Elizabeth Hospital of Montreal Foundation, Department of Pediatric Anesthesia, Montreal Children's Hospital, Montreal, QC, Canada.
Vanessa MarchesiniDepartment of Anaesthesia, Murdoch Children's Research Institute, Parkville, VIC, Australia.
Thomas RiedelDivision of Paediatric Critical Care, Department of Paediatrics, Children's Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Krisztina BodaDepartment of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
Walid HabreFaculty of Medicine, University of Geneva, Geneva, Switzerland.
Thomas RivaDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
NECTARINE Steering Committee
NECTARINE Group of the European Society of Anaesthesiology and Intensive Care Clinical Trial Network

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOptimal 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.

methodsWe 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).

resultsThe 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).

conclusionsRegardless 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 registrationClinicalTrials.gov (NCT02350348).

Indexed as

Intraoperative ComplicationsLung DiseasesPostoperative ComplicationsRespiration, ArtificialCohort StudiesEuropeFemaleHumansInfantInfant, NewbornMaleNeuromuscular Blocking AgentsRisk FactorsSecondary Data AnalysisNeuromuscular Blocking Agentsintraoperative respirationmechanical ventilationneonateneuromuscular blocking agentpaediatricpostoperative pulmonary complicationsrespiratory adverse events

Identifiers

PMID39979152
PMCPMC12597469

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.