Success rate and duration of orotracheal intubation of premature infants by healthcare providers with different levels of experience using a video laryngoscope as compared to direct laryngoscopy in a simulation-based setting

Background Although non-invasive respiratory support is often helpful to stabilize high-risk preterm infants immediately after birth, endotracheal intubation may still be needed in many cases [1].

In addition to endotracheal intubation for respiratory failure, intratracheal surfactant application via LISA (Less Invasive Surfactant Administration) or INSURE (Intubation-Surfactant-Extubation) strategies, requires laryngoscopy to access the trachea. Therefore, endotracheal intubation of very low birth weight infants (VLBWI) is an essential procedure in NICUs, but intubation experience is often limited.

Video laryngoscopy (VL) has been described as a tool to improve intubation skills, but studies in high-risk neonatal populations are limited.

Objective The aim of this study was to investigate whether VL is a useful tool to support airway management in high-risk premature infants with inexperienced operators.

Methods In this crossover study predominantly inexperienced participants were exposed in random sequence to VL and conventional direct laryngoscopy (DL) for endotracheal intubation of a VLBWI simulation manikin to measure total time, number of attempts, success rate on first attempt, view of the vocal cords and perceived subjective safety until successful intubation.

Results In our study group of 94 participants there was no significant difference in the total time (mean VL: 34 s (±24 s); DL: 37 s (±28 s), p+=+0.246), while the number of intubation attempts using VL was significantly lower (mean VL: 1.22 (±0.53); DL: 1.37 (±0.60), p+=+0.023). Success rate of VL during the first attempt was significantly higher (VL: 84%; DL 69%, p+=+0.016), view of the vocal cords was significantly better and perceived subjective safety was increased using VL.

Conclusions The results of our study suggest that using VL can be a useful tool to improve the rate of success and number of attempts when inexperienced healthcare providers have to perform endotracheal intubation in high-risk premature infants which may have an impact on child mortality and/or morbidity. The advantages include the possible use of VL as a teaching tool by guiding less experienced caretakers during the intubation process and to improve their perceived safety during the procedure, which may be an important aspect of staff performance.

Published in Front. Pediatr. 10:1031847. doi: 10.3389/fped.2022.1031847

Interessenkonflikt

Es bestehen keinerlei Interessenkonflikte oder finanzielle Abhängigkeiten.

• Literatur

• 1 Perkins GD, Gräsner JT, Semeraro F, Olasveengen T, Soar J, Lott C. et al. Executive summary: european resuscitation council guidelines 2021. Notfall und Rettungsmedizin 2021; 24: 274-345 10.1007/s10049-021-00883-z

Publication History

Article published online:
06 June 2023