Utilizing Video versus Direct Laryngoscopy to Intubate Simulated Newborns while Contained within the Incubator: A Randomized Crossover Study

Abstract

Objective The use of video laryngoscopy for intubating neonates in ergonomically challenging settings has not been studied well. We aimed to assess the usefulness of video laryngoscopy for experienced neonatologists to intubate neonatal manikins in incubators via side hand ports or head window. Study Design In this randomized crossover trial at three neonatal intensive care units in Japan, 27 neonatologists were randomized into two groups, namely, those intubating neonatal simulators using video laryngoscopy and then using direct laryngoscopy, or vice versa. The intubations were performed via hand ports or head window without opening top and side walls in incubators in two manikin positions (rotated 90° or unrotated). Glottis visualization (0–100%), success rate, intubation time, and ease of laryngoscopy (from 1 [very difficult] to 10 [very easy]) were compared between video laryngoscopy and direct laryngoscopy. Generalized linear models were used for the analyses. Results This study assessed 108 intubations performed by 27 neonatologists. The use of video laryngoscopy improved the glottis visualization by 14% (95% confidence interval, 7.4–20%; p < 0.01) and easiness scores of laryngoscopy by 0.8 (0.2–1.4; p < 0.01), but did not reduce the intubation time. Conclusion Video laryngoscopy is useful for experienced neonatologists for intubating neonatal manikins in incubators without opening the top or side walls.

Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates

“…Change in laryngoscope type was rare and did not increase the chance of second attempt success. Several studies have suggested benefits to VL as a training tool for less experienced neonatal staff, although evidence regarding broader settings and experience levels is less clear 7 20–22. A Cochrane systematic review of VL use in neonates reported increased success for the first attempt at TI, but no overall reduction in the number of TI attempts, with modest sample sizes and moderate to very low quality evidence 23.…”

“…Clinicians consider multiple personnel and equipment choices to use during TI attempts to improve the chance of TI success. The effects of physician training level, stylet use, premedication and family presence on first attempt success rates have been examined 2 5–8. An increased number of attempts is associated with an increased risk of adverse events,8 9 but no study has explored the factors associated with subsequent TI success following a failed first attempt for neonates.…”