Neonatal Intubation: Success of Pediatric Trainees

Leone, Tina A.; Rich, Wade; Finer, Neil N.

doi:10.1097/01.ogx.0000182889.58159.02

Cited by 66 publications

(111 citation statements)

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“…We compared intubation success rates between patients randomized to receive atropine and fentanyl with rocuronium (rocuronium group, RG) or without rocuronium (control group, CG) for nonemergent intubations during their NICU stay. For this randomized-controlled trial, all infants <35 6 7 weeks CGA were eligible for enrollment. Infants >36 weeks CGA already received rocuronium as part of premedication for intubation per our NICU protocol, and were therefore excluded from randomization and enrollment.…”

Section: Ethicsmentioning

confidence: 99%

“…5 Improving intubation success rates is worthwhile, given data that reveal more than half of all intubation attempts by pediatric residents are unsuccessful, leading to multiple attempts by caregivers to properly place the endotracheal tube. 6 As of March 2010, the American Academy of Pediatrics endorses the use of premedication for nonemergent intubation; the clinical report by Kumar et al 7 advocates for the administration of analgesic agents and states, 'vagolytic agents and rapid-onset muscle relaxants should be considered'.…”

Section: Introductionmentioning

confidence: 99%

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Rocuronium for nonemergent intubation of term and preterm infants

et al. 2010

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Objective: The aim of this study was to analyze clinical characteristics of rocuronium as premedication for nonemergent intubation in infants.Study Design: Preterm infants requiring nonemergent intubation were randomized to receive atropine and fentanyl with or without rocuronium. Outcomes, patient characteristics and intubator's experience were noted. Onset, duration and degree of clinical paralysis were recorded for rocuronium group and for older infants receiving rocuronium per unit protocol.Result: Forty-four intubations were randomized (20 rocuronium, 24 control). Groups were similar in chronological and corrected gestational age, weight and intubator's experience. Successful intubation on first attempt was achieved in 35% of intubations under rocuronium vs 8% of controls; rocuronium was the only significant variable by logistic regression (odds ratio ¼ 0.052, P ¼ 0.029). Complete paralysis was reported in 80% of 57 rocuronium intubations; onset ranged from 14 to 178 s (65.9±43.4), and duration from 1 to 60 min (16.3 ± 13.5).Conclusion: Rocuronium facilitated successful intubation and provided clinical paralysis quickly in most infants.

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Section: Ethicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rocuronium for nonemergent intubation of term and preterm infants

et al. 2010

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“…Anesthesia literature suggests that more than 40 procedures are necessary to become competent in the skill of intubation. 1,2 However, Leone et al 3 have previously demonstrated a reduction in the mean number of intubation opportunities per pediatric resident throughout training, with a corresponding reduction in the number of successful intubations performed. Other studies have shown that trainees, even on completion of their training, are frequently not competent in their performance of this technical skill.…”

Section: Introductionmentioning

confidence: 99%

Improved procedural performance following a simulation training session may not be transferable to the clinical environment

et al. 2011

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Objective: Neonatal intubation is a life-saving procedural skill required by pediatricians. Trainees receive insufficient clinical exposure to develop this competency. Traditional training comprises a Neonatal Resuscitation Program (NRP) complemented by clinical experience. More recently, simulation is being used in procedural skills training. The objective of this study is to examine the impact of a simulation session, which teaches the skill of neonatal intubation by comparing pre-and post-intervention performance, and examining transferability of skill acquisition to the clinical setting.Study Design: First-year pediatric residents with NRP training, but no previous neonatal experience, attended a 2-h intubation education session conducted by two experienced respiratory therapists. Individual components of the skill were taught, followed by practice on a highfidelity infant mannequin with concurrent feedback. Skills were assessed using a validated neonatal intubation checklist (CL) and a five-point global rating scale (GRS), pre-and immediately post-intervention, using the mannequin. Clinical intubations performed in the subsequent 8-week neonatal intensive-care unit (NICU) rotation were evaluated by documenting success rates, time taken to intubate, and CL and GRS scores. Performance was also compared with similar data collected on intubations performed by a historical cohort of first-year residents who did not receive the training intervention. Data were analyzed using descriptive statistics, Student's t-test and w 2 -test as appropriate, and analysis of variance.Result: Thirteen residents participated in the educational session. Mean pre-intervention CL score was 65.4 ± 18% (s.d.) and GRS was 3±0.7 (s.d.). Performance improved following the intervention with post-training CL score of 93 ± 5% (P<0.0001) and GRS of 3.92 ± 0.4 (P ¼ 0.0003). These trainees performed 40 intubations during their subsequent NICU rotation, with a success rate of 67.5% compared with 63.15% in the cohort group (NS). However, mean CL score for the study trainees during the NICU rotation was 64.6 ± 20%, significantly lower than their post-training CL score (P<0.001), and significantly lower than the historical cohort score of 82.5 ± 15.4% (P ¼ 0.001). In the intervention group, there were no significant differences between the pre-intervention and real-life CL scores of 65 ± 18% and 64.63 %, respectively, and the pre-intervention and real-life GRS of 3.0 ± 0.7 and 2.95 ± 0.86, respectively. Conclusion:Trainees showed significant improvement in intubation skills immediately post intervention, but this did not translate into improved-clinical performance, with performance returning to baseline. In fact, significantly higher CL scores were demonstrated by the cohort group. These data suggest that improved performance in the simulation environment may not be transferable to the clinical setting. They also support the evidence that although concurrent feedback may lead to improved performance immediately post training intervention, this do...

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“…Several studies that evaluated the success rate of neonatal endotracheal intubations have reported that successful intubations frequently require more than 1 attempt and are rarely accomplished within the currently recommended time frame. [1][2][3] Many failed attempts can be attributed to suboptimal intubating conditions. Excellent intubating conditions are characterized by good jaw relaxation, open and immobile vocal cords, and suppression of pharyngeal and laryngeal reflexes assessed by the absence of coughing or diaphragmatic movements in response to intubation.…”

Section: Introductionmentioning

confidence: 99%