Real-Time Intubation and Ventilation Feedback: A Randomized Controlled Simulation Study

Abstract

BACKGROUNDS: This study aimed to determine the best educational application of a respiratory function monitor and a video laryngoscope. METHODS: This study was a randomized controlled simulation-based trial, including 167 medical students. Participants had to execute ventilation and intubation maneuvers on a newborn manikin. Participants were randomized into 3 groups. In group A (no-access), the feedback devices were not visible but recording. In group B (supervisor-access), the feedback devices were visible to the supervisor only. In group C (full-access), both the participant and the supervisor had visual access. RESULTS: The two main outcome variables were the percentage of ventilations within the tidal volume target range (4–8mL/kg) and the number of intubation attempts. Group C achieved the highest percentage of ventilations within the tidal volume target range (full-access 63.6%, supervisor-access 51.0%, no-access 31.1%, P < .001) and the lowest mask leakage (full-access 34.9%, supervisor-access 46.6%, no-access 61.6%; A to B: P < .001, A to C: P < .001, B to C: P = .003). Overall, group C achieved superior ventilation quality regarding primary and secondary outcome measures. The number of intubation attempts until success was lowest in the full-access group (full-access: 1.29, supervisor-access: 1.77, no-access: 2.43; A to B: P = .001, A to C: P < .001, B to C: P = .015). CONCLUSIONS: Our findings confirm that direct visual access to feedback devices for supervisor and trainees alike considerably benefits outcomes and can contribute to the future of clinical education.

Design and Superior Performance of a New Endotracheal Tube to Avoid the Asphyxiation of Premature Infants

“…Up to one-half of endotracheal intubations of premature infants are associated with unintended intubations of the esophagus [1,2]. Esophageal intubation asphyxiates the newborn, can cause intraventricular hemorrhage, and has detrimental long-term consequences [3][4][5][6][7].…”