Technical realization of a sensorized neonatal intubation skill trainer for operators’ retraining and a pilot study for its validation

Abstract

BackgroundIn neonatal endotracheal intubation, excessive pressure on soft tissues during laryngoscopy can determine permanent injury. Low-fidelity skill trainers do not give valid feedback about this issue. This study describes the technical realization and validation of an active neonatal intubation skill trainer providing objective feedback.MethodsWe studied expert health professionals’ performances in neonatal intubation, underlining chance for procedure retraining. We identified the most critical points in epiglottis and dental arches and fixed commercial force sensors on chosen points on a ©Laerdal Neonatal Intubation Trainer. Our skill trainer was set up as a grade 3 on Cormack and Lehane’s scale, i.e. a model of difficult intubation. An associated software provided real time sound feedback if pressure during laryngoscopy exceeded an established threshold. Pressure data were recorded in a database, for subsequent analysis with non-parametric statistical tests. We organized our study in two intubation sessions (5 attempts each one) for everyone of our participants, held 24 h apart. Between the two sessions, a debriefing phase took place. In addition, we gave our participants two interview, one at the beginning and one at the end of the study, to get information about our subjects and to have feedback about our design.ResultsWe obtained statistical significant differences between consecutive attempts, with evidence of learning trends. Pressure on critical points was significantly lower during the second session (p < 0.0001). Epiglottis’ sensor was the most stressed (p < 0.000001). We found a significant correlation between time spent for each attempt and pressures applied to the airways in the two sessions, more significant in the second one (shorter attempts with less pressure, rs = 0.603).ConclusionsOur skill trainer represents a reliable model of difficult intubation. Our results show its potential to optimize procedures related to the control of trauma risk and to improve personnel retraining.Electronic supplementary materialThe online version of this article (10.1186/s13052-017-0435-z) contains supplementary material, which is available to authorized users.

The association between sex and most childhood cancers is not mediated by birthweight

“…Further, there is some evidence that the difference in cancer risk for boys and girls may lie in the immune response to tumor development. Males have lower innate and adaptive immune responses than females as demonstrated by higher rates of infectious diseases in males and greater levels of autoimmune diseases in females[10–13]. The X chromosome houses a large number of immune-related genes and differential expression of such genes [10,59], which may underlie the observed differences in immunity between males and females.…”

“…However, unlike adult cancers the mechanisms underlying the differences in childhood cancer incidence by sex are largely unknown[8]. Compared to females, male children are often of higher birthweight[9], experience a higher number of childhood infections[10–13], have an accelerated pubertal growth rate[14], and experience a different hormonal milieu over the childhood and adolescent periods[15]; therefore, these differences in risk factors may contribute to the observed sex disparity in childhood cancer incidence.…”

Effectiveness of a new sensorized videolaryngoscope for retraining on neonatal intubation in simulation environment

“…Simulation has proved to be an effective tool in the training of inexperienced medical personnel [12] and in retraining of experienced medical personnel on the technical skill of intubation, even in our previous research [13]. That study from our group focused on the retraining of medical personnel testing the effectiveness of a training platform consisting of a neonatal manikin sensorized in strength and position in the lower dental arch, superior dental arch and epiglottis: anatomical structures considered as the major critical point of damage during the intubation procedure [13]. Given the results and development fields of that study, in the present work we decided to sensorize the video-laryngoscope blade instead of the manikin.…”

“…Pediatric and newborns airways differ significantly from those of adults, especially because of larger tongue, shorter neck and jaw, smaller and more anterior airways and U-shape epiglottis (unlike the flat one in adults) [10,11]. Simulation has proved to be an effective tool in the training of inexperienced medical personnel [12] and in retraining of experienced medical personnel on the technical skill of intubation, even in our previous research [13]. That study from our group focused on the retraining of medical personnel testing the effectiveness of a training platform consisting of a neonatal manikin sensorized in strength and position in the lower dental arch, superior dental arch and epiglottis: anatomical structures considered as the major critical point of damage during the intubation procedure [13].…”

Sex differences in expression of immune elements emerge in children, young adults and mice with osteosarcoma

“…Many immune-related pathways differed by sex in TARGET-OS. In general, there are sex differences in innate and adaptive immune responses with females having more robust responses across the lifespan demonstrated by fewer early childhood infections and a higher incidence of autoimmune disease in adulthood [ 30 – 33 ]. Based on our previous work examining sex differences in childhood cancer incidence and outcomes [ 2 , 7 ], we hypothesized that the female immune system may contribute to their better survival, particularly for OS.…”