Telemedicine Versus Face-to-Face Evaluations by Respiratory Therapists of Mechanically Ventilated Neonates and Children: A Pilot Study

Abstract

BACKGROUND: Mechanical ventilation is one of the most important therapeutic interventions in neonatal and pediatric ICUs. Telemedicine has been shown to reliably extend pediatric intensivist expertise to facilities where expertise is limited. If reliable, telemedicine may extend the reach of pediatric respiratory therapists (RTs) to facilities where expertise does not exist or free up existing RT resources for important face-to-face activities in facilities where expertise is limited. The aim of this study was to determine how well respiratory assessments for ventilated neonates and children correlated when performed simultaneously by 2 RTs face-to-face and via telemedicine. METHODS: We conducted a pilot study including 40 assessments by 16 RTs on 11 subjects (5 neonatal ICU; 6 pediatric ICU). Anonymously completed intake forms by 2 different RTs concurrently assessing 14 ventilator-derived and patient-based respiratory variables were used to determine correlations. RESULTS: Forty paired assessments were performed. Median telemedicine assessment time was 8 min. The Pearson correlation coefficient (r) was used to determine agreement between continuous data, and the Cohen kappa statistics were used for binary variables. Pressure control, PEEP, breathing frequency, and F IO 2 perfectly correlated (r ‫؍‬ 1, all P < .001) as did the presence of a CO 2 monitor and need for increased ventilatory support (kappa ‫؍‬ 1). The Pearson correlation coefficient for V T , minute ventilation, mean airway pressure, and oxygen saturation ranged from 0.84 to 0.97 (all P < .001). kappa ‫؍‬ 0.41 (95% CI 0.02-0.80) for patient-triggered breaths, and kappa ‫؍‬ 0.57 (95% CI 0.19 -0.94) for breathing frequency higher than set frequency. kappa ‫؍‬ ؊0.25 (95% CI ؊0.46 to ؊0.04) for need for suctioning. CONCLUSIONS: Telemedicine technology was acceptable to RTs. Telemedicine evaluations highly correlated with face-to-face for 10 of 14 aspects of standard bedside respiratory assessment. Poor correlation was noted for more complex, patientgenerated parameters, highlighting the importance of further investigation incorporating a virtual stethoscope.

In-Hospital Telehealth Supports Care for Neonatal Patients in Strict Isolation

“…Video telemedicine has been well described for extending care to pediatric patients in geographically remote settings, including pediatric specialty consults such as neurology, genetics, and neonatology. [1][2][3] In these contexts, telemedicine has been demonstrated to be reliable in assessing critically ill children 4 and increases physician confidence in assessments when compared with telephone consults. 5 Typical inpatient care activities in the first 24 hours of admission are the admission history and examination, nighttime rounds by the on-call providers to check on the patient's status and morning interprofessional rounds, that is, conduct-ing interdisciplinary discussions, often at the patient's bedside along with parents or caregivers, with physicians, advanced practice providers (APPs), nurses, respiratory therapists, nutrition, pharmacy, physical and occupational therapy and social work to review the patient's course and decide on a plan of care.…”

“…Video telemedicine has been well described for extending care to pediatric patients in geographically remote settings, including pediatric specialty consults such as neurology, genetics, and neonatology. 1 2 3 In these contexts, telemedicine has been demonstrated to be reliable in assessing critically ill children 4 and increases physician confidence in assessments when compared with telephone consults. 5 …”

Lessons Learned from Burn Disasters in the Post-9/11 Era

“…Such advice can be invaluable to guide resuscitation, wound evaluation, patient sorting, and initial procedures such as escharotomy and fasciotomy. 16,17 …”

Quality Indices and Outcomes of a Neonatology Telerounding Program in a Level II Neonatal Intensive Care Unit: Single-Center Experience during the COVID-19 Pandemic

“…[4][5][6][7] There is early evidence of improved mortality with the use of teleconsultations. 16 Assessments of feasibility, quality, and outcomes have focused on physiological variables, 17 ventilated neonates, 18 and retinopathy of prematurity. 19 For neonatal telerounding, a hybrid in-person and telehealth program to support routine neonatal care in a Level II neonatal intensive care unit (NICU) described decreased length of stay with similar parental satisfaction.…”

“…4 5 6 7 There is early evidence of improved mortality with the use of teleconsultations. 16 Assessments of feasibility, quality, and outcomes have focused on physiological variables, 17 ventilated neonates, 18 and retinopathy of prematurity. 19…”