Utilizing Video versus Direct Laryngoscopy to Intubate Simulated Newborns while Contained within the Incubator: A Randomized Crossover Study

Yuri Ozawa; Shigehiro Takahashi; Humiko Miyahara; Kenichiro Hosoi; Mazumi Miura; Naho Morisaki; Yushi Ito; Tetsuya Isayama

doi:10.1055/s-0039-1683957

American Journal of Perinatology, Table of Contents

Am J Perinatol 2020; 37(05): 519-524
DOI: 10.1055/s-0039-1683957

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Utilizing Video versus Direct Laryngoscopy to Intubate Simulated Newborns while Contained within the Incubator: A Randomized Crossover Study

Yuri Ozawa

¹Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan

,

Shigehiro Takahashi

¹Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan

,

Humiko Miyahara

¹Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan

²Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Yonago, Japan

,

Kenichiro Hosoi

³Department of Pediatrics, Kyorin University School of Medicine, Tokyo, Japan

,

Mazumi Miura

²Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Yonago, Japan

,

Naho Morisaki

⁴Department of Social Medicine, Research Institute, National Center for Child Health and Development, Tokyo, Japan

,

Yushi Ito

¹Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan

,

Tetsuya Isayama

¹Division of Neonatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan

› Author Affiliations

Abstract

Objective The use of video laryngoscopy for intubating neonates in ergonomically challenging settings has not been studied well. We aimed to assess the usefulness of video laryngoscopy for experienced neonatologists to intubate neonatal manikins in incubators via side hand ports or head window.

Study Design In this randomized crossover trial at three neonatal intensive care units in Japan, 27 neonatologists were randomized into two groups, namely, those intubating neonatal simulators using video laryngoscopy and then using direct laryngoscopy, or vice versa. The intubations were performed via hand ports or head window without opening top and side walls in incubators in two manikin positions (rotated 90° or unrotated). Glottis visualization (0–100%), success rate, intubation time, and ease of laryngoscopy (from 1 [very difficult] to 10 [very easy]) were compared between video laryngoscopy and direct laryngoscopy. Generalized linear models were used for the analyses.

Results This study assessed 108 intubations performed by 27 neonatologists. The use of video laryngoscopy improved the glottis visualization by 14% (95% confidence interval, 7.4–20%; p < 0.01) and easiness scores of laryngoscopy by 0.8 (0.2–1.4; p < 0.01), but did not reduce the intubation time.

Conclusion Video laryngoscopy is useful for experienced neonatologists for intubating neonatal manikins in incubators without opening the top or side walls.

Keywords

video laryngoscopy - neonatal intensive care units - incubator - intubation

Full Text

References

References
1 Sawyer T, Foglia E, Hatch LD. , et al. Improving neonatal intubation safety: a journey of a thousand miles. J Neonatal Perinatal Med 2017; 10 (02) 125-131
2 Sauer CW, Kong JY, Vaucher YE. , et al. Intubation attempts increase the risk for severe intraventricular hemorrhage in preterm infants-a retrospective cohort study. J Pediatr 2016; 177: 108-113
3 Wallenstein MB, Birnie KL, Arain YH. , et al. Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants. J Perinatol 2016; 36 (02) 112-115
4 Wyllie JP. Neonatal endotracheal intubation. Arch Dis Child Educ Pract Ed 2008; 93 (02) 44-49
5 Deguines C, Dégrugilliers L, Ghyselen L, Chardon K, Bach V, Tourneux P. Impact of nursing care on temperature environment in preterm newborns nursed in closed convective incubators. Acta Paediatr 2013; 102 (03) e96-e101
6 Wilson E, Maier RF, Norman M. , et al; Effective Perinatal Intensive Care in Europe (EPICE) Research Group. Admission hypothermia in very preterm infants and neonatal mortality and morbidity. J Pediatr 2016; 175: 61-67
7 de Almeida MF, Guinsburg R, Sancho GA. , et al; Brazilian Network on Neonatal Research. Hypothermia and early neonatal mortality in preterm infants. J Pediatr 2014; 164 (02) 271-275
8 Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev 2016; 11: CD011136
9 Abdelgadir IS, Phillips RS, Singh D, Moncreiff MP, Lumsden JL. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev 2017; 5: CD011413
10 Sun Y, Lu Y, Huang Y, Jiang H. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth 2014; 24 (10) 1056-1065
11 Assaad MA, Lachance C, Moussa A. Learning neonatal intubation using the videolaryngoscope: a randomized trial on mannequins. Simul Healthc 2016; 11 (03) 190-193
12 Moussa A, Luangxay Y, Tremblay S. , et al. Videolaryngoscope for teaching neonatal endotracheal intubation: a randomized controlled trial. Pediatrics 2016; 137 (03) e20152156
13 Berg B, Walker RA, Murray WB, Boedeker BH. Airway intubation in a helicopter cabin: video vs. direct laryngoscopy in manikins. Aviat Space Environ Med 2009; 80 (09) 820-823
14 Hodd JA, Doyle DJ, Gupta S. , et al. A mannequin study of intubation with the AP advance and GlideScope Ranger videolaryngoscopes and the Macintosh laryngoscope. Anesth Analg 2011; 113 (04) 791-800
15 Narang AT, Oldeg PF, Medzon R, Mahmood AR, Spector JA, Robinett DA. Comparison of intubation success of video laryngoscopy versus direct laryngoscopy in the difficult airway using high-fidelity simulation. Simul Healthc 2009; 4 (03) 160-165
16 Ochroch EA, Hollander JE, Kush S, Shofer FS, Levitan RM. Assessment of laryngeal view; percentage of glottic opening score vs Cormack and Lehane grading. Can J Anaesth 1999; 46 (10) 987-990
17 O'Shea JE, Thio M, Kamlin CO. , et al. Videolaryngoscopy to teach neonatal intubation: a randomized trial. Pediatrics 2015; 136 (05) 912-919
18 Donoghue AJ, Ades AM, Nishisaki A, Deutsch ES. Videolaryngoscopy versus direct laryngoscopy in simulated pediatric intubation. Ann Emerg Med 2013; 61 (03) 271-277
19 Fiadjoe JE, Stricker PA, Hackell RS. , et al. The efficacy of the Storz Miller 1 video laryngoscope in a simulated infant difficult intubation. Anesth Analg 2009; 108 (06) 1783-1786
20 Fonte M, Oulego-Erroz I, Nadkarni L, Sanchez-Santos L, Iglesias-Vasquez A, Rodriguez-Nunez A. A randomized comparison of the GlideScope videolaryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios. Pediatr Emerg Care 2011; 27 (05) 398-402
21 Moreira A, Koele-Schmidt L, Leland M, Seidner S, Blanco C. Neonatal intubation with direct laryngoscopy vs videolaryngoscopy: an extremely premature baboon model. Paediatr Anaesth 2014; 24 (08) 840-844
22 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 (11) 1102-1107

Supplementary Material

Supplementary Material