A tiny baby intubation team improves endotracheal intubation success rate but decreases residents' training opportunities.
Journal
Journal of perinatology : official journal of the California Perinatal Association
ISSN: 1476-5543
Titre abrégé: J Perinatol
Pays: United States
ID NLM: 8501884
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
received:
15
07
2022
accepted:
17
10
2022
revised:
11
10
2022
pubmed:
31
10
2022
medline:
8
2
2023
entrez:
30
10
2022
Statut:
ppublish
Résumé
To assess the educational and clinical impact of a tiny baby intubation team (TBIT). Retrospective study comparing endotracheal intubation (ETI) performed: pre-implementation of a TBIT (T1), 6 months post-implementation (T2), and 4 years post-implementation (T3). Post-implementation (T2), first-attempt success rate in tiny babies increased (44% T1; 59% T2, p = 0.04; 56% T3, p = NS) and the proportion of ETIs performed by residents decreased (53% T1; 37% T2, p = 0.001; 45% T3, p = NS). After an educational quality improvement intervention (prioritizing non-tiny baby ETIs to residents, systematic simulation training and ETI using videolaryngoscopy), in T3 residents' overall (67% T1; 60% T2, p = NS; 79% T3, p = 0.02) and non-tiny baby ETI success rate improved (72% T1; 60% T2, p = NS; 82% T3, p = 0.02). A TBIT improves success rate of ETIs in ELBW infants but decreases educational exposure of residents. Educational strategies may help maintain resident procedural competency without impacting on quality of care.
Identifiants
pubmed: 36309565
doi: 10.1038/s41372-022-01546-8
pii: 10.1038/s41372-022-01546-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
215-219Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.
Références
Raju TN, Vidyasagar D, Torres C, Grundy D, Bennett EJ. Intracranial pressure during intubation and anesthesia in infants. J Pediatr. 1980;96:860–2.
doi: 10.1016/S0022-3476(80)80558-0
Friesen RH, Honda AT, Thieme RE. Changes in anterior fontanel pressure in preterm neonates during tracheal intubation. Anesth Analg. 1987;66:874–8.
Marshall TA, Deeder R, Pai S, Berkowitz GP, Austin TL. Physiologic changes associated with endotracheal intubation in preterm infants. Crit Care Med. 1984;12:501–3.
doi: 10.1097/00003246-198406000-00006
Hatch LD, Grubb PH, Lea AS, Walsh WF, Markham MH, Whitney GM, et al. Endotracheal intubation in neonates: a prospective study of adverse safety events in 162 infants. J Pediatr. 2016;168:62–66.e66.
doi: 10.1016/j.jpeds.2015.09.077
Stow PJ, McLeod ME, Burrows FA, Creighton RE. Anterior fontanelle pressure responses to tracheal intubation in the awake and anaesthetized infant. Br J Anaesth. 1988;60:167–70.
doi: 10.1093/bja/60.2.167
Miller KE, Singh N. Association of multiple tracheal intubation attempts with clinical outcomes in extremely preterm infants: a retrospective single-center cohort study. J Perinatol. 2022;42:1216–20.
Wallenstein MB, Birnie KL, Arain YH, Yang W, Yamada NK, Huffman LC, et al. Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants. J Perinatol. 2016;36:112–5.
doi: 10.1038/jp.2015.158
Johnston L, Sawyer T, Ades A, Moussa A, Zenge J, Jung P, et al. Impact of physician training level on neonatal tracheal intubation success rates and adverse events: a report from National Emergency Airway Registry for Neonates (NEAR4NEOS). Neonatology. 2021;118:434–42.
Sanders RC Jr, Giuliano JS Jr, Sullivan JE, Brown CA III, Walls RM, Nadkarni V, et al. Level of trainee and tracheal intubation outcomes. Pediatrics. 2013;131:e821–e828.
doi: 10.1542/peds.2012-2127
Morris M, Cleary JP, Soliman A. Small baby unit improves quality and outcomes in extremely low birth weight infants. Pediatrics. 2015;136:e1007–e1015.
doi: 10.1542/peds.2014-3918
O’Donnell CP, Kamlin CO, Davis PG, Morley CJ. Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics. 2006;117:e16–e21.
doi: 10.1542/peds.2005-0901
Gozzo YF, Cummings CL, Chapman RL, Bizzarro MJ, Mercurio MR. Who is performing medical procedures in the neonatal intensive care unit? J Perinatol. 2011;31:206–11.
doi: 10.1038/jp.2010.121
Moussa A, Luangxay Y, Tremblay S, Lavoie J, Aube G, Savoie E, et al. Videolaryngoscope for teaching neonatal endotracheal intubation: a randomized controlled trial. Pediatrics. 2016;137:1–8.
doi: 10.1542/peds.2015-2156
Assaad MA, Lachance C, Moussa A. Learning neonatal intubation using the videolaryngoscope: a randomized trial on mannequins. Simul Health. 2016;11:190–3.
doi: 10.1097/SIH.0000000000000141
Foglia EE, Ades A, Sawyer T, Glass KM, Singh N, Jung P, et al. Neonatal intubation practice and outcomes: an international registry study. Pediatrics. 2019;143:e20180902.
Downes KJ, Narendran V, Meinzen-Derr J, McClanahan S, Akinbi HT. The lost art of intubation: assessing opportunities for residents to perform neonatal intubation. J Perinatol. 2012;32:927–32.
doi: 10.1038/jp.2012.17
Haubner LY, Barry JS, Johnston LC, Soghier L, Tatum PM, Kessler D, et al. Neonatal intubation performance: room for improvement in tertiary neonatal intensive care units. Resuscitation. 2013;84:1359–64.
doi: 10.1016/j.resuscitation.2013.03.014
Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM. et al. Part 13: neonatal resuscitation: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S543–S560.
doi: 10.1161/CIR.0000000000000267
Donoghue AJ, Ades AM, Nishisaki A, Deutsch ES. Videolaryngoscopy versus direct laryngoscopy in simulated pediatric intubation. Ann Emerg Med. 2013;61:271–7.
doi: 10.1016/j.annemergmed.2012.09.008
Sawyer T, Foglia E, Hatch LD, Moussa A, Ades A, Johnston L, et al. Improving neonatal intubation safety: a journey of a thousand miles. J Neonatal Perinat Med. 2017;10:125–31.
doi: 10.3233/NPM-171686
Mills DM, Williams DC, Dobson JV. Simulation training as a mechanism for procedural and resuscitation education for pediatric residents: a systematic review. Hosp Pediatr. 2013;3:167–76.
doi: 10.1542/hpeds.2012-0041
Finan E, Bismilla Z, Campbell C, Leblanc V, Jefferies A, Whyte HE. Improved procedural performance following a simulation training session may not be transferable to the clinical environment. J Perinatol. 2012;32:539–44.
doi: 10.1038/jp.2011.141
Surcouf JW, Chauvin SW, Ferry J, Yang T, Barkemeyer B. Enhancing residents’ neonatal resuscitation competency through unannounced simulation-based training. Med Educ Online. 2013;18:1–7.
doi: 10.3402/meo.v18i0.18726
O’Shea JE, Thio M, Kamlin CO, McGrory L, Wong C, John J, et al. Videolaryngoscopy to teach neonatal intubation: a randomized trial. Pediatrics. 2015;136:912–9.
doi: 10.1542/peds.2015-1028
Volz S, Stevens TP, Dadiz R. A randomized controlled trial: does coaching using video during direct laryngoscopy improve residents’ success in neonatal intubations? J Perinatol. 2018;38:1074–80.
doi: 10.1038/s41372-018-0134-7
Lingappan K, Arnold JL, Fernandes CJ, Pammi M. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane Database Syst Rev. 2018;6:Cd009975.
Vlatten A, Aucoin S, Litz S, Macmanus B, Soder C. A comparison of the STORZ video laryngoscope and standard direct laryngoscopy for intubation in the Pediatric airway—a randomized clinical trial. Paediatr Anaesth. 2009;19:1102–7.
doi: 10.1111/j.1460-9592.2009.03127.x
Hodgson KA, Owen LS, Kamlin COF, Roberts CT, Newman SE, Francis KL, et al. Nasal high-flow therapy during neonatal endotracheal intubation. N Engl J Med. 2022;386:1627–37.
doi: 10.1056/NEJMoa2116735