Reply to: Differences in intubators' visual attention during neonatal endotracheal intubation

Abstract

Letter to the EditorReply to: Differences in intubators' visual attention during neonatal endotracheal intubation Thank you for the thoughtful letter reflecting on the differences between our observational study on visual attention during endotracheal intubation 1 and the simulation study by Wagner et al. 2 In addition to the reasons cited by Gröpel et al., there may be other reason why visual attention differ between simulated and real endotracheal intubations. First, team composition and teamwork may have a significant impact how our intubators perform and how they divided their visual attention. At our institution, endotracheal intubation is a team effort, with many tasks delegated to team members other than the intubator. Specifically, equipment preparation is delegated to respiratory therapists, and medication preparation delegated to nurses. This allows our intubators to focus more on the infant and less on the equipment.Another possible explanation is that much of the information obtained from patient observation may be difficult to duplicate in simulation. Even using hi-fidelity manikins, participants may not feel that they obtain the same amount of information from the manikin then they would from an actual patient. In our observations, intubators paid particular attention to the respiratory effort of the infant, evidence of adequate mask ventilation through chest raise, and examined for signs of efficacy of muscle relaxation. In a study comparing visual attention in simulated vs. actual anesthetic cases, a similar observation was made where anesthetists focused less on the manikin then they did on actual patients. 3 Both simulation and real-life studies provide valuable information on human factors related to critical healthcare tasks such as endotracheal intubations. Furthermore, as we move towards using simulation as a training tool, it is imperative that we gain an understanding in the differences in HCP behaviors during simulated vs. real clinical tasks. As opportunities to practice real life neonatal endotracheal intubation decrease, simulation play a crucial role in providing a controlled, safe, and reproducible environment for both training and research.