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Lee WJ, Lee HY, Kim SJ, Lee KH. The Clinical Usability Evaluation of an Attachable Video Laryngoscope in the Simulated Tracheal Intubation Scenario: A Manikin Study. Bioengineering (Basel) 2024; 11:570. [PMID: 38927806 PMCID: PMC11200530 DOI: 10.3390/bioengineering11060570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
The aim of this study was to assess the usefulness of an attachable video laryngoscope (AVL) by attaching a camera and a monitor to a conventional Macintosh laryngoscope (CML). Normal and tongue edema airway scenarios were simulated using a manikin. Twenty physicians performed tracheal intubations using CML, AVL, Pentax Airwayscope® (AWS), and McGrath MAC® (MAC) in each scenario. Ten physicians who had clinical experience in using tracheal intubation were designated as the skilled group, and another ten physicians who were affiliated with other departments and had little clinical experience using tracheal intubation were designated as the unskilled group. The time required for intubation and the success rate were recorded. The degree of difficulty of use and glottic view assessment were scored by participants. All 20 participants successfully completed the study. There was no difference in tracheal intubation success rate and intubation time in the normal airway scenario in both skilled and unskilled groups. In the experienced group, AWS had the highest success rate (100%) in the tongue edema airway scenario, followed by AVL (60%), MAC (60%), and CML (10%) (p = 0.001). The time required to intubate using AWS was significantly shorter than that with AVL (10.2 s vs. 19.2 s) or MAC (10.2 s vs. 20.4 s, p = 0.007). The difficulty of using AVL was significantly lower than that of CML (7.8 vs. 2.8; p < 0.001). For the experienced group, AVL was interpreted as being inferior to AWS but better than MAC. Similarly, in the unskilled group, AVL had a similar success rate and tracheal intubation time as MAC in the tongue edema scenario, but this was not statistically significant. The difficulty of using AVL was significantly lower than that of CML (8.8 vs. 3.3; p < 0.001). AVL may be an alternative for VL.
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Affiliation(s)
| | | | | | - Kang-Hyun Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Gangwon State, Republic of Korea; (W.-J.L.); (H.-Y.L.); (S.-J.K.)
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Pinheiro JMB, Munshi UK, Chowdhry R. Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube-Literature Review and Experience at a Tertiary Center. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020361. [PMID: 36832490 PMCID: PMC9955846 DOI: 10.3390/children10020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
Unintended endobronchial placement is a common complication of neonatal tracheal intubation and a threat to patient safety, but it has received little attention towards decreasing its incidence and mitigating associated harms. We report on the key aspects of a long-term project in which we applied principles of patient safety to design and implement safeguards and establish a safety culture, aiming to decrease the rate of deep intubation (beyond T3) in neonates to <10%. Results from 5745 consecutive intubations revealed a 47% incidence of deep tube placement at baseline, which decreased to 10-15% after initial interventions and remained in the 9-20% range for the past 15 years; concurrently, rates of deep intubation at referring institutions have remained high. Root cause analyses revealed multiple contributing factors, so countermeasures specifically aimed at improving intubation safety should be applied before, during, and immediately after tube insertion. Extensive literature review, concordant with our experience, suggests that pre-specifying the expected tube depth before intubation is the most effective and simple intervention, although further research is needed to establish accurate and accepted standards for estimating the expected depth. Presently, team training on intubation safety, plus possible technological advances, offer additional options for safer neonatal intubations.
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Uchinami Y, Fujita N, Ando T, Mizunoya K, Hoshino K, Yokota I, Morimoto Y. The relationship between years of anesthesia experience and first-time intubation success rate with direct laryngoscope and video laryngoscope in infants: a retrospective observational study. J Anesth 2022; 36:707-714. [PMID: 36125551 PMCID: PMC9487847 DOI: 10.1007/s00540-022-03106-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022]
Abstract
Purpose Studies in adults have reported that video laryngoscope is more useful than direct laryngoscope when training less experienced anesthesiologists. However, whether this is true for infants remains unclear. Therefore, this study aimed to evaluate whether the use of video laryngoscope would result in smaller differences in success rate according to anesthesiologists’ expertise than those in direct laryngoscope. Methods Medical records and video recordings from the operating room of patients aged < 1 year who underwent non-cardiac surgery between March 2019 and September 2021 were reviewed. Tracheal intubations between April 8, 2020, and June 20, 2021, were excluded due to the shortage of video laryngoscope blades during the COVID-19 pandemic. Rates of first-time tracheal intubation success were compared by years of anesthesia experience and initial intubation device. Results In total, 125 of 175 tracheal intubations were analyzed (direct laryngoscope group, n = 72; video laryngoscope group, n = 53). The first-time tracheal intubation success rate increased with years of experience as an anesthesiologist in the direct laryngoscope group (odds ratio OR 1.70, 95% confidence interval CI 1.15, 2.49; P = 0.0070), but not the video laryngoscope group (OR 0.99, 95% CI 0.74, 1.35; P = 0.99). Conclusion The differences in success rate according to the anesthesiologists’ years of experience were non-significant when using video laryngoscope in infants, compared to those in direct laryngoscope. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-022-03106-y.
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Affiliation(s)
- Yuka Uchinami
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan.
| | - Noriaki Fujita
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan
| | - Takashi Ando
- Department of Anesthesiology, Hakodate Central Hospital, 3-2 Honcho, 040-8585, Hakodate, Japan
| | - Kazuyuki Mizunoya
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan
| | - Koji Hoshino
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, N15 W7, Sapporo, 060-8638, Japan
| | - Yuji Morimoto
- Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 060-8648, Japan
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Kuijpers LJMK, Binkhorst M, Yamada NK, Bouwmeester RN, van Heijst AFJ, Halamek LP, Hogeveen M. Validation of an Instrument for Real-Time Assessment of Neonatal Intubation Skills: A Randomized Controlled Simulation Study. Am J Perinatol 2022; 39:195-203. [PMID: 32898921 DOI: 10.1055/s-0040-1715530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study aimed to evaluate the construct validity and reliability of real-time assessment of a previously developed neonatal intubation scoring instrument (NISI). STUDY DESIGN We performed a randomized controlled simulation study at a simulation-based research and training facility. Twenty-four clinicians experienced in neonatal intubation ("experts") and 11 medical students ("novices") performed two identical elective intubations on a neonatal patient simulator. Subjects were randomly assigned to either the intervention group, receiving predefined feedback between the two intubations, or the control group, receiving no feedback. Using the previously developed NISI, all intubations were assessed, both in real time and remotely on video. Construct validity was evaluated by (1) comparing the intubation performances, expressed as percentage scores, with and without feedback, and (2) correlating the intubation performances with the subjects' level of experience. The intrarater reliability, expressed as intraclass correlation coefficient (ICC), of real-time assessment compared with video-based assessment was determined. RESULTS The intervention group contained 18 subjects, the control group 17. Background characteristics and baseline intubation scores were comparable in both groups. The median (IQR) change in percentage scores between the first and second intubation was significantly different between the intervention and control group (11.6% [4.7-22.8%] vs. 1.4% [0.0-5.7%], respectively; p = 0.013). The 95% CI for this 10.2% difference was 2.2 to 21.4%. The subjects' experience level correlated significantly with their percentage scores (Spearman's R = 0.70; p <0.01). ICC's were 0.95 (95% CI: 0.89-0.97) and 0.94 (95% CI: 0.89-0.97) for the first and second intubation, respectively. CONCLUSION Our NISI has construct validity and is reliable for real-time assessment. KEY POINTS · Our neonatal intubation scoring instrument has construct validity.. · Our instrument can be reliably employed to assess neonatal intubation skills directly in real time.. · It is suitable for formative assessment, i.e., providing direct feedback during procedural training..
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Affiliation(s)
- Lindie J M K Kuijpers
- Department of Neonatology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Mathijs Binkhorst
- Department of Neonatology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nicole K Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford University School of Medicine, Palo Alto, California
| | - Romy N Bouwmeester
- Department of Neonatology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Arno F J van Heijst
- Department of Neonatology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford University School of Medicine, Palo Alto, California
| | - Marije Hogeveen
- Department of Neonatology, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
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O'Shea JE, Edwards G, Kirolos S, Godden C, Brunton A. Implementation of a Standardized Neonatal Intubation Training Package. J Pediatr 2021; 236:189-193.e2. [PMID: 33940014 DOI: 10.1016/j.jpeds.2021.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the first attempt neonatal intubation success rates of pediatric trainees following the implementation of an evidence-based training package. STUDY DESIGN Data collection was undertaken from February, 1 2017, to January 31, 2018, to ascertain baseline preimplementation intubation success rates. An intubation training package, which included the use of videolaryngoscopy, preprocedure pause, and standardized instruction during the procedure, was introduced. Data on all subsequent intubations were collected prospectively from May 1, 2018, to April 30, 2020. RESULTS Preimplementation baseline data over a 1-year period demonstrated overall first attempt intubation success rate of junior trainees to be 37% (33/89). After implementation of the training package, 290 intubations were analyzed over a 2-year period. The overall success rate was 67% (194/290); 61% (117/192) for junior trainees and 79% (77/98) for senior clinicians. Three or more attempts were required for 13% of intubations (38/290). During the study period, the overall number of intubations being carried out decreased. Intubations with the videolaryngoscope had higher success rates for all tiers of clinician, most marked in the junior tiers. CONCLUSIONS The introduction of a standardized intubation training package, along with videolaryngoscopy, improved trainee intubation success rates.
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Affiliation(s)
- Joyce E O'Shea
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Gemma Edwards
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom.
| | - Sandy Kirolos
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Cliodhna Godden
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Andrew Brunton
- Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom
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Cavallin F, Res G, Monfredini C, Doglioni N, Villani PE, Weiner G, Trevisanuto D. Time needed to intubate and suction a manikin prior to instituting positive pressure ventilation: a simulation trial. Eur J Pediatr 2021; 180:247-252. [PMID: 32749547 PMCID: PMC7782398 DOI: 10.1007/s00431-020-03759-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid (MSAF) is supposed to delay initiation of positive pressure ventilation (PPV), but the magnitude of such delay is unknown. To compare the time of PPV initiation when performing immediate laryngoscopy with intubation and suctioning vs. performing immediate PPV without intubation in a manikin model. Randomized controlled crossover (AB/BA) trial comparing PPV initiation with or without endotracheal suctioning in a manikin model of non-vigorous neonates born through MSAF. Participants were 20 neonatologists and 20 pediatric residents trained in advanced airway management. Timing of PPV initiation was longer with vs. without endotracheal suctioning in both pediatric residents (mean difference 13 s, 95% confidence interval 8 to 18 s; p < 0.0001) and neonatologists (mean difference 12 s, 95% confidence interval 8 to 16 s; p < 0.0001). The difference in timing of PPV initiation was similar between pediatric residents and neonatologists (mean difference - 1 s, 95% confidence interval - 7 to 6 s; p = 0.85).Conclusions: Performing immediate laryngoscopy with intubation and suctioning was associated with longer-but not clinically relevant-time of initiation of PPV compared with immediate PPV without intubation in a manikin model. While suggesting negligible delay in starting PPV, further studies in a clinical setting are warranted.Registration: clinicaltrial.gov NCT04076189. What is Known: • Management of the non-vigorous newborn delivered through meconium-stained amniotic fluid remains still controversial. • Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid is supposed to delay initiation of positive pressure ventilation, but the magnitude of such delay is unknown. What is New: • Performing immediate ventilation without intubation was associated with shorter-but not clinically relevant-time of initiation of ventilation compared to immediate laryngoscopy with intubation and suctioning in a manikin model. • Further studies in a clinical setting are warranted.
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Affiliation(s)
| | - Giulia Res
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128 Padova, Italy
| | | | - Nicoletta Doglioni
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128 Padova, Italy
| | | | - Gary Weiner
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI USA
| | - Daniele Trevisanuto
- Department of Women and Children Health, University of Padova, Via Giustiniani, 3, 35128, Padova, Italy.
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Calevo MG, Veronese N, Cavallin F, Paola C, Micaglio M, Trevisanuto D. Supraglottic airway devices for surfactant treatment: systematic review and meta-analysis. J Perinatol 2019; 39:173-183. [PMID: 30518796 DOI: 10.1038/s41372-018-0281-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/26/2018] [Accepted: 10/24/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare surfactant administration via supraglottic airway device (SAD) vs. nasal CPAP alone or INSURE. STUDY DESIGN A systematic search of PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials and Clinicaltrials.gov was performed. Articles meeting inclusion criteria (RCT, surfactant administration via SAD, laryngeal mask, I-gel) were assessed RESULTS: Five RCTs were eligible. Surfactant administration via SAD reduced the need for intubation/mechanical ventilation (RR 0.57, 95%CI 0.38-0.85) and short-term oxygen requirements (MD -8.00, 95%CI -11.09 to -4.91) compared to nCPAP alone. Surfactant administration via SAD reduced the need for intubation/mechanical ventilation (RR 0.43, 95%CI 0.31-0.61), but increased short-term oxygen requirements (MD 3.10, 95%CI 0.51-5.69) compared to INSURE approach. CONCLUSIONS In preterm infants with RDS, surfactant administration via SAD reduces the need for intubation/mechanical ventilation. Overall, available literature includes few, small, poor-quality studies. Surfactant administration via SAD should be limited to clinical trials.
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Affiliation(s)
- Maria Grazia Calevo
- Epidemiology, Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | | | | | - Massimo Micaglio
- Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy.
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Wong J, Finan E, Campbell D. Use of Simulation in Canadian Neonatal-Perinatal Medicine Training Programs. Cureus 2017; 9:e1448. [PMID: 28929032 PMCID: PMC5590774 DOI: 10.7759/cureus.1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/08/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction Simulation is used for the delivery of education and on occasion assessment. Before such a tool is used routinely in neonatal training programs across Canada, a need assessment is required to determine its current usage by accredited training programs. Our aim was to characterize the type of simulation modalities used and the perceived simulation-based training needs in Canadian neonatal-perinatal medicine (NPM) training programs. Methods A 22-item and 13-item online descriptive survey was sent to all NPM program directors and fellows in Canada, respectively. The survey was modeled on a previously validated tool by Johnston, et al. and responses were collected over 30 days. Results In total, eight (63%) program directors and 24 (28%) fellows completed the survey, with all respondents indicating that simulation is being used. Both lab-based and in situ simulations are occurring, with a range of simulation modalities employed to primarily teach resuscitation, procedural and communication skills. Fellows indicated that simulation should also be used to also teach other important topics, including disease-specific management, crisis resource management, and prevention of medical error. Five (63%) programs have faculty with formal simulation training and four (50%) programs have at least one faculty involved in simulation research. Conclusion Simulation is widely used in Canadian NPM training programs, with program directors and fellows identifying this as an important tool. Simulation can be used to teach a range of skills, but programs need to align their curriculum with both training objectives and learner needs. There is an opportunity for faculty development and increased simulation research.
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Sawyer T, French H, Ades A, Johnston L. Neonatal-perinatal medicine fellow procedural experience and competency determination: results of a national survey. J Perinatol 2016; 36:570-4. [PMID: 26938919 DOI: 10.1038/jp.2016.19] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Ensuring that neonatal-perinatal medicine (NPM) fellows attain competency in performing neonatal procedures is a requirement of training-competent neonatologists. STUDY DESIGN A survey of NPM fellows was performed to determine the procedural experience of current fellows, investigate techniques used to track procedural experience and examine the methods programs use to verify procedural competency. RESULTS One hundred and sixty-three fellows in 57 accredited training programs responded to the survey. Reported number of procedures provide contemporary normative data on procedural experience during training. The majority of fellows reported using an online reporting system to track experience. The most common technique to verify procedural competency was supervised practice until an arbitrary number of procedures had been performed. CONCLUSIONS NPM fellow procedural experience increases significantly for most, but not all, procedures duration training. We speculate that supplemental simulation training for rare neonatal procedures would help ensure the competency of graduating NPM fellows. Experience alone is insufficient to verify competency. Further work on the accurate tracking of experience and verification of procedural competency is needed.
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Affiliation(s)
- T Sawyer
- University of Washington School of Medicine, Division of Neonatology, Seattle, WA, USA
| | - H French
- Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA
| | - A Ades
- Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA, USA
| | - L Johnston
- Yale School of Medicine, Division of Neonatology, New Haven, CT, USA
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Neonatal Resuscitation Training: Implications of Course Construct and Discipline Compartmentalization on Role Confusion and Role Ambiguity. Adv Neonatal Care 2016; 16:201-10. [PMID: 27140032 DOI: 10.1097/anc.0000000000000294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Neonatal Resuscitation Program's (NRP's) Sixth Edition introduced simulation-based training (SBT) into neonatal life support training. SBT offers neonatal emergency response teams a safe, secure environment to rehearse coordinated neonatal resuscitations. Teamwork and communication training can reduce tension and anxiety during neonatal medical emergencies. PURPOSE To discuss the implications of variability in number and type of simulation scenario, number and type of learners who comprise a course, and their influence upon scope of practice, role confusion, and role ambiguity. METHODS Relevant articles from MEDLINE, CINAHL, EMBASE, Google Scholar, the World Health Organization, the American Heart Association, and NRP were included in this integrative review of the literature. FINDINGS/RESULTS Purposeful synergy of optimal SBT course construct with teamwork and communication can resist discipline compartmentalization, role confusion, and role ambiguity. Five key themes were identified and coined the "5 Rights" of NRP SBT. These "5 Rights" can guide healthcare institutions with planning, implementation, and evaluation of NRP SBT courses. IMPLICATIONS FOR PRACTICE NRP SBT can facilitate optimal team function and reduce errors when teams of learners and varied scenarios are woven into the course construct. The simulated environment must be realistic and fully equipped to encourage knowledge transfer and attainment of the NRP's key behavioral outcomes. IMPLICATIONS FOR RESEARCH Investigation of teamwork and communication training with NRP SBT, course construct, discipline compartmentalization, and behavioral and clinical outcomes is indicated. Investigation of outcomes of SBT using a team-teaching model, combining basic and advanced practice NRP instructors, is indicated.
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Yang C, Zhu X, Lin W, Zhang Q, Su J, Lin B, Ye H, Yu R. Randomized, controlled trial comparing laryngeal mask versus endotracheal intubation during neonatal resuscitation---a secondary publication. BMC Pediatr 2016; 16:17. [PMID: 26811060 PMCID: PMC4727391 DOI: 10.1186/s12887-016-0553-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022] Open
Abstract
Background This study aimed to study the feasibility, efficacy and safety of using laryngeal mask (LM) ventilation compared with endotracheal intubation (ETI) during neonatal resuscitation. Methods Neonates with a heart rate below 60 beats per minute despite 30 s of face mask ventilation were assigned quasi-randomly (odd/even birth date) to LM (n = 36) or ETI (n = 32) ventilation. Differences in first attempt insertion success, insertion time, Apgar score, resuscitation outcome, and adverse effects were compared. Results There were no significant differences in first attempt at successful insertion (LM, 94.4 % vs. ETI, 90.6 %), insertion time (LM, 7.58 ± 1.16 s vs. ETI, 7.89 ± 1.52 s), Apgar score at 1 and 5 min, response time, ventilation time, successful resuscitation (LM, 86.1 % vs. ETI, 96.9 %), and adverse events (LM, n =3 vs. ETI, n =4) between groups. Conclusions Laryngeal mask ventilation is an effective alternative to endotracheal intubation during resuscitation of depressed newborns who do not respond to face-mask ventilation. During an emergency, laryngeal mask ventilation may be a preferred technique for medical staff who are unable to acquire or maintain endotracheal intubation skills. Trial registration: Current Controlled Trials ChiCTR-IOQ-15006488. Registered on 2 June 2015.
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Affiliation(s)
- Chuanzhong Yang
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China.
| | - Xiaoyu Zhu
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Weibin Lin
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Qianshen Zhang
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Jinqiong Su
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Bingchun Lin
- Neonatal Department, Shenzhen Maternal and Child Healthcare Hospital Affiliated to Southern Medical University, No.2004 Hong Li Road, Futian District, Shenzhen, 518028, China
| | - Hongmao Ye
- Neonatal Department, the Third Hospital of Peking University, Beijing, China
| | - Renjie Yu
- Neonatal Department, the First Hospital Affiliated to Tsinghua University, Beijing, China
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Who Should Perform Critical Procedures on Children Prehospital, and How Often? Pediatr Crit Care Med 2015; 16:785-6. [PMID: 26427814 DOI: 10.1097/pcc.0000000000000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Trevisanuto D, Cavallin F, Nguyen LN, Nguyen TV, Tran LD, Tran CD, Doglioni N, Micaglio M, Moccia L. Supreme Laryngeal Mask Airway versus Face Mask during Neonatal Resuscitation: A Randomized Controlled Trial. J Pediatr 2015; 167:286-91.e1. [PMID: 26003882 DOI: 10.1016/j.jpeds.2015.04.051] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/05/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effectiveness of supreme laryngeal mask airway (SLMA) over face mask ventilation for preventing need for endotracheal intubation at birth. STUDY DESIGN We report a prospective, randomized, parallel 1:1, unblinded, controlled trial. After a short-term educational intervention on SLMA use, infants ≥34-week gestation and/or expected birth weight ≥1500 g requiring positive pressure ventilation (PPV) at birth were randomized to resuscitation by SLMA or face mask. The primary outcome was the success rate of the resuscitation devices (SLMA or face mask) defined as the achievement of an effective PPV preventing the need for endotracheal intubation. RESULTS We enrolled 142 patients (71 in SLMA and 71 in face mask group, respectively). Successful resuscitation rate was significantly higher with the SLMA compared with face mask ventilation (91.5% vs 78.9%; P = .03). Apgar score at 5 minutes was significantly higher in SLMA than in face mask group (P = .02). Neonatal intensive care unit admission rate was significantly lower in SLMA than in face mask group (P = .02). No complications related to the procedure occurred. CONCLUSIONS In newborns with gestational age ≥34 weeks and/or expected birth weight ≥1500 g needing PPV at birth, the SLMA is more effective than face mask to prevent endotracheal intubation. The SLMA is effective in clinical practice after a short-term educational intervention. TRIAL REGISTRATION Registered with ClinicalTrials.gov: NCT01963936.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Women and Children Health, University of Padua, Azienda Ospedaliera di Padova, Padova, Italy; Amici della Neonatologia Trentina, Trento, Italy.
| | | | - Loi Ngoc Nguyen
- Department of Neonatal Intensive Care, National Hospital of Obstetrics and Gynecology, Ha Noi, Viet Nam
| | - Tien Viet Nguyen
- Department of Neonatal Intensive Care, National Hospital of Obstetrics and Gynecology, Ha Noi, Viet Nam
| | - Linh Dieu Tran
- Department of Neonatal Intensive Care, National Hospital of Obstetrics and Gynecology, Ha Noi, Viet Nam
| | - Chien Dinh Tran
- Breath of Life Program - East Meets West Foundation, Oakland, CA
| | - Nicoletta Doglioni
- Department of Women and Children Health, University of Padua, Azienda Ospedaliera di Padova, Padova, Italy
| | - Massimo Micaglio
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Luciano Moccia
- Amici della Neonatologia Trentina, Trento, Italy; Breath of Life Program - East Meets West Foundation, Oakland, CA
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Trevisanuto D, Cavallin F, Mardegan V, Loi NN, Tien NV, Linh TD, Chien TD, Doglioni N, Chiandetti L, Moccia L. LMA Supreme for neonatal resuscitation: study protocol for a randomized controlled trial. Trials 2014; 15:285. [PMID: 25027230 PMCID: PMC4223364 DOI: 10.1186/1745-6215-15-285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 06/27/2014] [Indexed: 11/20/2022] Open
Abstract
Background The most important action in the resuscitation of a newborn in the delivery room is to establish effective assisted ventilation. The face mask and endotracheal tube are the devices used to achieve this goal. Laryngeal mask airways that fit over the laryngeal inlet have been shown to be effective for ventilating newborns at birth and should be considered as an alternative to facemask ventilation or endotracheal intubation among newborns weighing >2,000 g or delivered ≥34 weeks’ gestation. A recent systematic review and meta-analysis of supraglottic airways in neonatal resuscitation reported the results of four randomized controlled trials (RCTs) stating that fewer infants in the group using laryngeal mask airways required endotracheal intubation (1.5%) compared to the group using face masks (12.0%). However, there were methodological concerns over all the RCTs including the fact that the majority of the operators in the trials were anesthesiologists. Our hypothesis is based on the assumption that ventilating newborns needing positive pressure ventilation with a laryngeal mask airway will be more effective than ventilating with a face mask in a setting where neonatal resuscitation is performed by midwives, nurses, and pediatricians. The primary aim of this study will be to assess the effectiveness of the laryngeal mask airway over the face mask in preventing the need for endotracheal intubation. Methods/design This will be an open, prospective, randomized, single center, clinical trial. In this study, 142 newborns weighing >1,500 g or delivered ≥34 weeks gestation needing positive pressure ventilation at birth will be randomized to be ventilated with a laryngeal mask airway (LMA SupremeTM, LMA Company, UK - intervention group) or with a face mask (control group). Primary outcome: Proportion of newborns needing endotracheal intubation. Secondary outcomes: Apgar score at 5 minutes, time to first breath, onset of the first cry, duration of resuscitation, death or moderate to severe hypoxic-ischemic encephalopathy within 7 days of life. Trial registration ClinicalTrials.gov identifier: NCT01963936 (October 11, 2013).
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Affiliation(s)
- Daniele Trevisanuto
- Department of Women and Children Health, University of Padua, Via Giustiniani, 3, Azienda Ospedaliera di Padova, Padova 35128, Italy.
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15
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Ernst KD, Cline WL, Dannaway DC, Davis EM, Anderson MP, Atchley CB, Thompson BM. Weekly and consecutive day neonatal intubation training: comparable on a pediatrics clerkship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:505-510. [PMID: 24448036 DOI: 10.1097/acm.0000000000000150] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine whether medical student intubation proficiency with a neonatal mannequin differs according to weekly or consecutive day practice sessions during a six-week pediatric clerkship. METHOD From July 2010 through June 2011, the authors prospectively randomized 110 third-year medical students into three neonatal intubation practice groups: standard (control; no practice sessions), weekly (practice once/week for four consecutive weeks), or consecutive day (practice once/day for four consecutive days). At baseline, students performed intubation during individual sessions using a neonatal mannequin (SimNewB). Two reviewers, blinded to practice group, viewed videotapes of intubations and independently scored students on equipment selection, procedural skill steps, length of intubation attempts (in seconds), and the number of attempts (up to three) needed for a successful intubation. Videotaped individual final assessment intubation sessions during week six were evaluated in the same manner. RESULTS Students in the weekly and consecutive day practice groups performed better at the final assessment on all variables than students in the standard group (P < .001), but over six weeks, the authors detected no differences between the two distributed practice formats for any outcomes of interest. CONCLUSIONS Practice improved all aspects of neonatal intubation performance, including choosing the correct equipment, properly performing the skill steps, length of time to successful intubation, and success rate, for novice health care providers in a simulation setting. Over six weeks, neither practice format proved superior, but it remains unclear whether one format is superior for learning and skill retention over the long term or in actual practice.
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Affiliation(s)
- Kimberly D Ernst
- Dr. Ernst is associate professor and director of medical education in newborn medicine, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Cline was, at the time of this study, neonatology fellow, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, and she is currently a clinical neonatologist in private practice, CoxHealth South, Springfield, Missouri. Dr. Dannaway is assistant professor and assistant director, Neonatal Fellowship Program, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Ms. Davis is a graduate student, Division of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Anderson is assistant professor and statistician, Division of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Atchley was, at the time of this study, neonatology fellow, and she is currently assistant professor, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Dr. Thompson is assistant dean for medical education and is affiliated with the Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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