Videolaryngoscope for Teaching Neonatal Endotracheal Intubation: A Randomized Controlled Trial

Moussa, Ahmed; Luangxay, Y; Tremblay, Sophie; Lavoie, Julie; Aube, G; Savoie, E; Lachance, Christian

doi:10.1542/peds.2015-2156

Cited by 66 publications

(54 citation statements)

References 22 publications

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“…The authors of 2 recent randomized trials demonstrated that using video laryngoscopy to teach intubation improves neonatal TI success rates among pediatric trainees, but neither trial contained comprehensive reports on adverse events. 28,29 In our study, esophageal intubation with immediate recognition was the most common adverse TIAE. We can speculate that video laryngoscopy may reduce esophageal intubation by allowing senior providers to use the video display to monitor and guide inexperienced providers through laryngoscopy and endotracheal tube insertion.…”

Section: Figurementioning

confidence: 55%

Neonatal Intubation Practice and Outcomes: An International Registry Study

et al. 2019

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for the NEAR4NEOS Investigators BACKGROUND AND OBJECTIVES: Neonatal tracheal intubation is a critical but potentially dangerous procedure. We sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety. METHODS:We developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. Safety outcomes included adverse tracheal intubation-associated events (TIAEs) and severe oxygen desaturation (≥20% decline in oxygen saturation). We examined the relationship between intubation characteristics and adverse events with univariable tests and multivariable logistic regression. RESULTS:We captured 2009 NICU intubations and 598 DR intubations from 10 centers. Pediatric residents attempted 15% of NICU and 2% of DR intubations. In the NICU, the first attempt success rate was 49%, adverse TIAE rate was 18%, and severe desaturation rate was 48%. In the DR, 46% of intubations were successful on the first attempt, with 17% TIAE rate and 31% severe desaturation rate. Site-specific TIAE rates ranged from 9% to 50% (P < .001), and severe desaturation rates ranged from 29% to 69% (P = .001). Practices independently associated with reduced TIAEs in the NICU included video laryngoscope (adjusted odds ratio 0.46, 95% confidence interval 0.28-0.73) and paralytic premedication (adjusted odds ratio 0.38, 95% confidence interval 0.25-0.57). CONCLUSIONS:We implemented a novel multisite neonatal intubation registry and identified potentially modifiable factors associated with adverse events. Our results will inform future interventional studies to improve neonatal intubation safety. abstract NIH WHAT'S KNOWN ON THIS SUBJECT: Endotracheal intubation is a critical skill in neonatology but is less frequently performed than in previous years because of changes in neonatal practice. Little is known about the current practice and safety outcomes of neonatal intubation in the academic setting. WHAT THIS STUDY ADDS:Pediatric residents rarely perform neonatal intubation. Only half of first intubation attempts are successful, and adverse events and severe oxygen desaturation are common. Paralytic premedication and video laryngoscopy are associated with decreased adverse events in the NICU.

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Section: Figurementioning

confidence: 55%

Neonatal Intubation Practice and Outcomes: An International Registry Study

et al. 2019

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“…Simulation studies have reported improved intubation success rates using videolaryngoscopy [46,48]. Recently, two clinical trials have examined the benefits of videolaryngoscope use during neonatal intubation [49,50].…”

Section: Alternative Methods Of Intubating Neonatesmentioning

confidence: 99%

“…The second study by Moussa et al randomly assigned 34 junior pediatric residents to perform endotracheal intubations using either the videolaryngoscope (C-MAC, Karl Storz, Tuttlingen, Germany) or the classic direct laryngoscope [50]. Residents in that study performed 213 intubations on 198 infants at a median corrected gestational age of 32 weeks and a median weight of approximately 1,500 g. Overall intubation success rate was higher with videolaryngoscopy (75% vs. 63%, p = 0.03), and residents reached competency (defined as success rate of over 80%) more rapidly with the videolaryngoscope (2nd vs. 7th intubation).…”

Section: Alternative Methods Of Intubating Neonatesmentioning

confidence: 99%

Improving neonatal intubation safety: A journey of a thousand miles

Sawyer

Foglia

Hatch

et al. 2017

NPM

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Abstract. Neonatal intubation is one of the most common procedures performed by neonatologists, however, the procedure is difficult and high risk. Neonates who endure the procedure often experience adverse events, including bradycardia and severe oxygen desaturations. Because of low first attempt success rates, neonates are often subjected to multiple intubation attempts before the endotracheal tube is successfully placed. These factors conspire to make intubation one of the most dangerous procedures in neonatal medicine. In this commentary we review key elements in the journey to improve neonatal intubation safety. We begin with a review of intubation success rates and complications. Then, we discuss the importance of intubation training. Next, we examine quality improvement efforts and patient safety research to improve neonatal intubation safety. Finally, we evaluate new tools which may improve success rates, and decrease complications during neonatal intubation.

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“…Furthermore, using the laryngoscope during an attempt would allow better guidance during the procedure, and reviewing the trainee’s own intubation attempt captured with a videolaryngoscope could reinforce their understanding of what went wrong and how it could be corrected to improve their intubation skills. One randomised controlled trial confirmed that learners have a higher neonatal intubation success rate when using a videolaryngoscope, compared with a classic laryngoscope technique,12 while another one confirmed that success rate is higher when trainees shared their view on a videolaryngoscope screen with an instructor 13…”

Section: Discussionmentioning

confidence: 99%