Videographic Assessment of Pediatric Tracheal Intubation Technique During Emergency Airway Management

Abstract

Intubators commonly exhibited suboptimal technique during tracheal intubation such as bending deeply at the waist, having their eyes close to the patient's mouth, failing to widely open the patient's mouth, and not elevating the occiput in older children. Retraction of the right corner of the patient's mouth by an assistant during laryngoscopy and intubation was associated with TI success.

Comparison of Miller laryngoscope and UEScope videolaryngoscope for endotracheal intubation in four pediatric airway scenarios: a randomized, crossover simulation trial

“…Their application depends on the clinical settings and the intubator’s experience. Many studies have been carried out on the role of videolaryngoscopy in normal and difficult airway in pediatric patients [12, 18, 23, 24, 30, 32]. Some suggest that videolaryngoscopes offer no benefit over direct laryngoscopy performed by emergency department personnel with regard to the rate of first-pass intubation success, complications, or successful intubation [3].…”

“…The participants performed intubation in four scenarios:Scenario A: normal airway without chest compressions.Scenario B: difficult airway without chest compressions. The simulator control software inflated the tongue to simulate conditions of Mallampati scale grade III [18]. Scenario C: normal airway with uninterrupted chest compressions.…”

“…Scenario B: difficult airway without chest compressions. The simulator control software inflated the tongue to simulate conditions of Mallampati scale grade III [18].…”

“…A complication of failed endotracheal intubation is hypoxemia [4]. A way to reduce the potential complications, including airway edema, is to decrease the number of total intubation attempts and the procedure duration, which is possible with better or alternative intubation technique, including videolaryngoscopy [14, 18]. Fiadjoe et al suggest that more than two direct laryngoscopy attempts in children with difficult airway are associated with a high rate of failure and severe complications [4].…”

Repurposing Video Review Infrastructure for Clinical Resuscitation Care in the Age of COVID-19

“…[1][2][3] Members of our group have reported on the use of video review as a means of assessing performance during cardiopulmonary resuscitation (CPR) and intubation. [4][5][6][7] Since 2012, the ED at the Children's Hospital of Philadelphia has maintained a robust video-based quality improvement program. All resuscitations (both medical and trauma) are recorded with a multicamera video system (B-Line Medical, Washington, DC), which uses a combination of 3 video angles, 2 audio feeds, and the vital sign monitor (Figure 1).…”