Impact of Physician Training Level on Neonatal Tracheal Intubation Success Rates and Adverse Events: A Report from National Emergency Airway Registry for Neonates (NEAR4NEOS)

Abstract

<b><i>Introduction:</i></b> Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed. <b><i>Methods:</i></b> Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference). <b><i>Results:</i></b> Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; <i>p</i> < 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; <i>p</i> = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; <i>p</i> < 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11–0.30) for residents and 0.80 (95% CI: 0.51–1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation. <b><i>Conclusion:</i></b> Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical.

Laryngeal Mask Ventilation during Neonatal Resuscitation: A Case Series

“…The top barriers to healthcare provider acceptance or adherence to change are grouped into categories, such as cognitive-behavioral, attitudinal, professional, support, and system more so than the lack of convincing evidence [ 8 ]. The attitude that an ETT is superior to LM or the professional barrier requiring physician trainees to focus on mastering intubation skills [ 9 , 10 ] would be difficult to overcome. The authors believe we have addressed many of these barriers, as also identified in the survey portion of the project, by improving LM training and awareness, increasing provider confidence in placement, and addressing organizational hurdles related to job description and availability of the device through our collaborative effort.…”

Nasal high-flow therapy to Optimise Stability during Intubation: the NOSI pilot trial

“…Neonatal intubation is an essential procedure that all neonatologists need to be competent and proficient in performing. The procedure in this population is complicated not just by the small size of the baby but also by the unique physiology of the newb,orn which leads to decreased reserve and less apnoeic tolerance during laryngoscopy 10–16. As infants are surviving at lower gestational ages and birth weights than before, the procedure is only likely to become more challenging.…”

“…The procedure in this population is complicated not just by the small size of the baby but also by the unique physiology of the newb,orn which leads to decreased reserve and less apnoeic tolerance during laryngoscopy. [10][11][12][13][14][15][16] As infants are surviving at lower gestational ages and birth weights than before, the procedure is only likely to become more challenging. As the difficulty increases, procedural experience is decreasing due to greater use of non-invasive ventilation, a reduction in working hours and significantly increased numbers of not just trainees but also consultants.…”

Neonatal Simulation Program: A 5 Years Educational Journey From Qatar

“…In this workshop, we used the incubator (Giraffe Incubator Carestation, GE Healthcare, United States) ventilator (Dräger Babylog® VN500), manikin (Premature Anne, Laerdal Medical), and all the other equipment used in the neonatal resuscitation program course. This workshop has a didactic session with video materials, a complex timed preterm inter-professional resuscitation scenario using a medium-fidelity manikin, followed by a post-resuscitation team debriefing ( 18 , 19 ).…”

“…It is important to mention that most of our tracheal intubations are performed by neonatal-perinatal fellows and advanced neonatal providers e.g., specialists and consultants rather than the trainee paediatric residents. This explains the gradual decrease in opportunities for trainee paediatric residents to perform tracheal intubation in their neonatology rotations ( 19 ).…”