Videolaryngoscopy aids instruction in neonatal intubation

By Will Boggs MD

NEW YORK (Reuters Health) - The use of videolaryngoscopy is associated with improved neonatal intubation rates by inexperienced trainees, researchers report.

"Videolaryngoscopy is an effective tool to use to teach neonatal intubation," Dr. Joyce E. O'Shea from Royal Hospital for Children, Glasgow, Scotland, told Reuters Health by email.

Reported first-attempt success rates of intubators range from 44% to 73%, with lower rates in residents (20% to 63%). For various reasons, there are few opportunities for neonatal trainees to acquire and maintain proficiency, so their already low success rates seem to be on the decline.

Dr. O'Shea's team sought to determine whether supervision using a modified traditional Miller videolaryngoscope improves pediatric residents' first-attempt neonatal intubation success rates in a randomized controlled trial that included 206 intubations (104 with the videolaryngoscope screen visible and 102 with the screen covered) by 36 residents.

Success rates were significantly higher when the instructor was able to watch the videolaryngoscope screen (66%) than when the screen was covered (41%), according to the October 19 Pediatrics online report.

Success rates were higher with the videolaryngoscope visible than with it covered regardless of whether premedication was given (72% versus 44%, respectively) or not given (50% versus 30%, respectively).

The two approaches did not differ in rates of hypoxia or bradycardia or in the duration of the attempts.

"As with using any new equipment, there is a learning curve in how best to use it," Dr. O'Shea said. "Our aim was that for the residents the experience would be as similar as possible to the traditional approach, and the feedback we received from them would suggest that that was largely well achieved."

"Before guiding the intubations, all instructors were given training on how to use the equipment, saw videos recorded beforehand, and saw other instructors guiding," she explained. "For our study, residents were randomized more than once and could be in either the control group or the intervention group, so it is not possible to track success rates of different residents over time."

Unfortunately, Dr. O'Shea said, videolaryngoscopes for neonates are not widely available. "Most of them do not have blades small enough or appropriately shaped to be used in neonates, especially extremely preterm infants," she said. "Most available scopes also do not make disposable blades. There are, however, several models in production, so this will hopefully improve with time."

Dr. Cengiz Karsil, attending anesthesiologist from the Hospital for Sick Children, Toronto, Ontario, Canada, told Reuters Health by email, "Videolaryngoscopes may be very useful teaching aides when it comes to neonatal tracheal intubation. Unlike direct laryngoscopy, videolaryngoscopy allows the attending anesthesiologist to see where the tip of the blade is and what sort of laryngoscopic view the student has obtained."

"Videolaryngoscopy is being used with increasing frequency as a first-line intubating device by anesthesiologists as well as non-anesthesiologist first-responders," Dr. Karsil said. "However, teaching proper pediatric direct laryngoscopy technique remains an important part of any pediatric anesthesiology training program."

The Royal Women's Hospital of Melbourne, Australia and the Australian National Health and Research Council supported this research.

SOURCE: http://bit.ly/1GnUFL7

Pediatrics 2015.

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