Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates

Lingappan, Krithika; Arnold, Jennifer; Shaw, Thomas L.; Fernandes, Caraciolo J; Pammi, Mohan

doi:10.1002/14651858.cd009975

Cited by 29 publications

(39 citation statements)

References 18 publications

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“…A recent systematic review found that insufficient evidence exists to recommend or refute the use of videolaryngoscopy for endotracheal intubation in neonates and called for randomized controlled studies to address efficacy and safety. 16 The aim of this study was to determine if supervision using a modified traditional Miller videolaryngoscope improves pediatric residents' first-attempt neonatal intubation success rates.…”

Section: What This Study Addsmentioning

confidence: 99%

Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

et al. 2015

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BACKGROUND: Neonatal endotracheal intubation is a necessary skill. However, success rates among junior doctors have fallen to ,50%, largely owing to declining opportunities to intubate. Videolaryngoscopy allows instructor and trainee to share the view of the pharynx. We compared intubations guided by an instructor watching a videolaryngoscope screen with the traditional method where the instructor does not have this view.METHODS: A randomized, controlled trial at a tertiary neonatal center recruited newborns from February 2013 to May 2014. Eligible intubations were performed orally on infants without facial or airway anomalies, in the delivery room or neonatal intensive care, by doctors with ,6 months' tertiary neonatal experience. Intubations were randomized to having the videolaryngoscope screen visible to the instructor or covered (control). The primary outcome was first-attempt intubation success rate confirmed by colorimetric detection of expired carbon dioxide.RESULTS: Two hundred six first-attempt intubations were analyzed. Median (interquartile range) infant gestation was 29 (27 to 32) weeks, and weight was 1142 (816 to 1750) g. The success rate when the instructor was able to view the videolaryngoscope screen was 66% (69/104) compared with 41% (42/102) when the screen was covered (P , .001, OR 2.81, 95% CI 1.54 to 5.17). When premedication was used, the success rate in the intervention group was 72% (56/78) compared with 44% (35/79) in the control group (P , .001, OR 3.2, 95% CI 1.6 to 6.6).CONCLUSIONS: Intubation success rates of inexperienced neonatal trainees significantly improved when the instructor was able to share their view on a videolaryngoscope screen. WHAT'S KNOWN ON THIS SUBJECT:Endotracheal intubation is a mandatory skill for neonatal trainees. It is a difficult skill to acquire, and success rates of junior doctors are low and falling.WHAT THIS STUDY ADDS: Videolaryngoscopy allows the supervisor to share the intubator' s view of the airway and provide more informed guidance. Teaching intubation using a videolaryngoscope with the screen visible to the instructor results in significantly higher success rates for inexperienced doctors.

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Section: What This Study Addsmentioning

confidence: 99%

Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

et al. 2015

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“…The role of videolaryngoscopes in children or neonates is not as clear as in adults: videolaryngoscopes do not feature in the 2015 Association of Paediatric Anaesthetists of Great Britain and Ireland and Difficult Airway Society guidelines and a 2014 Cochrane review concluded that videolaryngoscope use in paediatrics was not necessarily advantageous and could lead to prolonged tracheal intubation times . In addition, a 2015 Cochrane review of videolaryngoscope use in neonates concluded that there was insufficient evidence to recommend its use . However, with regard to paediatric practice, work in 2016 by the PeDI register identified that the success rate of tracheal intubation at first attempt was higher with videolaryngoscope use, and that, following initial failure with direct laryngoscopy, earlier transition to a videolaryngoscope led to fewer airway management complications .…”

Section: Discussionmentioning

confidence: 99%

Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC‐NIC survey

et al. 2018

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In 2011, the Fourth National Audit Project (NAP4) reported high rates of airway complications in adult intensive care units (ICUs), including death or brain injury, and recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring. More than 80% of UK adult intensive care units have subsequently changed practice. Undetected oesophageal intubation has recently been listed as a 'Never Event' in UK practice, with capnography mandated. We investigated whether the NAP4 recommendations have been embedded into paediatric and neonatal intensive care practice by conducting a telephone survey of senior medical or nursing staff in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). Response rates were 100% for paediatric intensive care units and 90% for neonatal intensive care units. A difficult airway policy existed in 67% of paediatric intensive care units and in 40% of neonatal intensive care units; a pre-intubation checklist was used in 70% of paediatric intensive care units and in 42% of neonatal intensive care units; a difficult intubation trolley was present in 96% of paediatric intensive care units and in 50% of neonatal intensive care units; a videolaryngoscope was available in 55% of paediatric intensive care units and in 29% of neonatal intensive care units; capnography was 'available' in 100% of paediatric intensive care units and in 46% of neonatal intensive care units, and 'always available' in 100% of paediatric intensive care units and in 18% of neonatal intensive care units. Death or serious harm occurring secondary to complications of airway management in the last 5 years was reported in 19% of paediatric intensive care units and in 26% of neonatal intensive care units. We conclude that major gaps in optimal airway management provision exist in UK paediatric intensive care units and especially in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new 'Never Event' and has the potential to improve airway management.

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“…subgroups of patients may benefit from tailored strategies). EMS providers should regularly review current literature for continued relevance and consult separate guidelines for selected patient populations such as neonatal and obstetric patients …”

Section: Discussionmentioning

confidence: 99%

Scandinavian SSAI clinical practice guideline on pre‐hospital airway management

Rehn

Hyldmo

Magnússon

et al. 2016

Acta Anaesthesiol Scand

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BackgroundThe Scandinavian society of anaesthesiology and intensive care medicine task force on pre‐hospital airway management was asked to formulate recommendations following standards for trustworthy clinical practice guidelines.MethodsThe literature was systematically reviewed and the grading of recommendations assessment, development and evaluation (GRADE) system was applied to move from evidence to recommendations.ResultsWe recommend that all emergency medical service (EMS) providers consider to: apply basic airway manoeuvres and airway adjuncts (good practice recommendation); turn unconscious non‐trauma patients into the recovery position when advanced airway management is unavailable (good practice recommendation); turn unconscious trauma patients to the lateral trauma position while maintaining spinal alignment when advanced airway management is unavailable [strong recommendation, low quality of evidence (QoE)]. We suggest that intermediately trained providers use a supraglottic airway device (SAD) or basic airway manoeuvres on patients in cardiac arrest (weak recommendation, low QoE). We recommend that advanced trained providers consider using an SAD in selected indications or as a rescue device after failed endotracheal intubation (ETI) (good practice recommendation). We recommend that ETI should only be performed by advanced trained providers (strong recommendation, low QoE). We suggest that videolaryngoscopy is considered for ETI when direct laryngoscopy fails or is expected to be difficult (weak recommendation, low QoE). We suggest that advanced trained providers apply cricothyroidotomy in ‘cannot intubate, cannot ventilate’ situations (weak recommendation, low QoE).ConclusionThis guideline for pre‐hospital airway management includes a combination of techniques applied in a stepwise fashion appropriate to patient clinical status and provider training.

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Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates

Cited by 29 publications

References 18 publications

Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

Videolaryngoscopy to Teach Neonatal Intubation: A Randomized Trial

Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC‐NIC survey

Scandinavian SSAI clinical practice guideline on pre‐hospital airway management

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