Efficacy and safety of videolaryngoscopy-guided verbal feedback to teach neonatal and infant intubation. A prospective randomised cross over study

Abstract

Background and Aims: Neonatal endotracheal intubation is challenging due to the miniature anatomy, which is distinct from adults and reserves only less oxygen and time before desaturation begins. As a result, teaching neonatal intubation becomes fraught with difficulties. This study aimed to determine the efficacy and safety of videolaryngoscopy-guided verbal feedback compared to conventional laryngoscopy verbal feedback in neonatal and infant intubation. Methods: In this prospective randomised cross over study, 24 trainees were randomly allocated to two groups, video-assisted verbal feedback followed by conventional verbal feedback (V/C) and conventional verbal feedback followed by video-assisted verbal feedback (C/V). one hundred forty-four ASA grade I-II patients aged 1 day to 6 months requiring general anaesthesia with endotracheal intubation were included. Each trainee performed three intubations with one technique and switched to other technique to perform three more intubations. Primary outcome was first attempt success rate and secondary outcomes were time to best view, time to intubation, ease of intubation, manoeuvres used and complications. Results: Overall first attempt intubation success rate was higher with video-assisted verbal feedbacks compared to conventional verbal feedback (83.3% vs. 44.4%, P value = <0.001). The time to best view (19.8 s vs. 26.8 s, P value = <0.001) and intubation (30 s vs. 41.7 s) was achieved faster with video-assisted part of the study. Conclusion: Our study results show that video-assisted verbal feedback to trainees resulted in high intubation success rate and reduced complications like oesophageal intubation and desaturation in neonatal and infant intubations.

Keywords

• Cross over study
• endotracheal intubation
• infant
• videolaryngoscopy