Neonatal videolaryngoscopy as a teaching aid: the trainees’ perspective

Abstract

IntroductionNeonatal intubation is a challenging skill to acquire. A randomised controlled trial (RCT) found junior trainees had higher intubation success rates if their supervisor shared their airway view on a videolaryngoscope screen compared with intubations where the supervisor could not see the videolaryngoscope screen. The intubations in the trial were supervised by a group of experienced neonatologists who developed an intubation teaching package that aimed to be informative, consistent and supportive. We surveyed the trainees to assess their experiences of the intubation attempts.MethodsTrainees participating in the RCT completed questionnaires anonymously after each intubation attempt. Questionnaires used 5-point Likert scales and free comment sections. Quantitative analysis was performed using descriptive statistics. In a qualitative analysis, free comments were coded to identify central recurring themes.ResultsTwo hundred and six questionnaires were completed by 36 trainees. The majority reported that the guidance received during intubation was helpful, the postprocedure feedback was educational and their confidence levels were increased. Trainees appreciated a controlled environment and calm, consistent guidance. They found intubations in the delivery room, those involving unstable infants, large audiences and parental presence more stressful. Responses were positive whether the videolaryngoscope screen was visible or covered, emphasising the importance of consistent guidance. Overall, 16% of intubations were reported as intimidating.ConclusionThe shared airway view offered by videolaryngoscopy was well received. In addition, taking measures to control the setting, with standardised guidance and feedback, improved confidence and created a more positive learning experience.

Does videolaryngoscopy improve tracheal intubation first attempt success in the NICUs? A report from the NEAR4NEOS

“…The benefit in using VL for trainees has been greatly described in three clinical trials showing improved first attempt success rate without increasing time to intubation [ 14 – 16 , 18 ]. Trainees describe that VL use allowed for better guidance from supervisors throughout the procedure and that it improved their confidence [ 15 , 19 ]. In our study, as residents attempted only 13% of intubations, VL was also used for TIs performed by other categories of providers.…”

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

“…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 17–20. In response to this, many strategies have been employed to try and either reduce the need for intubation,21–23 provide greater stability medically during the procedure24 25 or improve education and therefore proficiency of the intubator 26–36. Despite these strategies, intubation remains a problem and by comparison to adult studies our population show high rates of physiological instability and adverse events 5 37–40…”

Thiel embalming in neonates: methodology and benefits in medical training

“…A child is not a “small adult” and the differences are greater at a younger age and size. Techniques such as laparoscopy (Ade-Ajayi et al 2013 ), placement of a central catheter (Thomas et al 2013 ) or neonatal and pediatric intubation (O’Shea et al 2020 ; Ernst et al 2014 ) are all performed in pediatric training. Many of these techniques are learned with simulators, high-fidelity pediatric manikins (Azzie et al 2011 ) or 3D models (Rose et al 2015 ) and, in certain cases, on real patients.…”