Just-in-Time Video Laryngoscopy Versus Direct Laryngoscopy for Neonatal Intubation

Abstract

As neonatal endotracheal intubation (ETI) is a low-frequency, high-consequence event, it is essential that providers have access to resources to aid in ETI. We sought to determine the impact of video laryngoscopy (VL) with just-in-time training on intubation outcomes over direct laryngoscopy (DL) when performed by neonatal nurses. We conducted a prospective, randomized, crossover study with neonatal nurses employed at a level 2 neonatal intensive care unit (NICU). Nurses performed both DL and VL on a neonatal mannequin using a CMAC (Karl Storz Corp, Tuttlingen, Germany) either with the assistance of the screen (VL) or without (DL). Before performing the intubation, providers were given a just-in-time, brief education presentation and allowed to practice with the device. Each ETI attempt was reviewed to obtain the percentage of glottic opening (POGO) score, time to intubation (TTI, time from insertion of the blade into the mouth until the first breath was delivered), and time from blade insertion until the best POGO score. We enrolled 19 participants, with a median (interquartile range) of 20 (9-26) years of experience and having a median of 2 (1-3) intubations within the past year. None had used VL in the NICU previously. Median TTI did not differ between DL and VL: 19.9 (15.3-41.5) vs 20.3 (17.9-24.4) (P = 1). POGO scores and the number of attempts also did not differ between DL and VL. In our simulated setting, just-in-time VL training provided similar intubation outcomes compared with DL in ETI performed by neonatal nurses. Just-in-time VL education may be an alternative to traditional DL for neonatal intubations.

Intubation of a Patient with a Large Goiter: The Advantageous Role of Videolaryngoscopy

“…It was seen that the use of videolaryngoscopy yielded a faster time to tracheal intubation than fiberoptic bronchoscopy [13, 14]. In another study by Grgurich et al, there was no significant difference in time to tracheal intubation and first attempt success between videolaryngoscopy and awake fiberoptic intubation [15]. Other papers have alluded to the use of a combination of the above-mentioned methods, usually after failure to intubate by conventional means.…”

Success rate and duration of orotracheal intubation of premature infants by healthcare providers with different levels of experience using a video laryngoscope as compared to direct laryngoscopy in a simulation-based setting

“…VL improved the view of the glottis in both uncomplicated and difficult intubation situations, increased the success rate in the first attempt at intubation, and reduced the rate of complications, such as damage to oral structures, bradycardias and brief hypoxia (7)(8)(9)(10)(11)(12). Furthermore, several studies in children have confirmed the advantages of VL in difficult intubation conditions and the possibility to reduce TIAEs (tracheal intubation associated events) (13)(14)(15). In particular, VL has shown that it is a suitable and helpful tool for teaching inexperienced medical professionals (13,(16)(17)(18).…”

Emergency Pediatric Intubations in an Urban Children’s Hospital Before and After Just-in-Time Training for Video Laryngoscopy

“…Just-in-time training (JITT), which originated in the automotive industry, is a planned, on-the-job, short unit of instruction provided on-demand in close proximity to the need for the training [7]. JITT has demonstrated increased learner confidence in lumbar puncture, improved skill in VL and pediatric advanced life support, and decreased procedural skill decay in transvenous pacing catheter placement [8][9][10][11]. Its advantages include short time for training, in-situ location for training, and availability for repeated training.…”