Videolaryngoscope for Teaching Neonatal Endotracheal Intubation: A Randomized Controlled Trial
Videolaryngoscope for Teaching Neonatal Endotracheal Intubation: A Randomized Controlled Trial
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DOI：
10.1542/peds.2015-2156
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发表时间：
2016-03-01
期刊：
影响因子：
8
通讯作者：
Lachance, Christian
中科院分区：
文献类型：
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作者：
Moussa, Ahmed;Luangxay, Yvon;Lachance, Christian
目的：评价视频喉镜(VL)在获得新生儿气管插管(ETI)技能方面是否优于经典喉镜(CL)，以及一旦VL获得，技能是否可移植给CLL。方法：这项随机对照试验在加拿大一家三级医院进行，招募了在NICU进行ETI的儿科青年住院医生。主要结果是ETI的成功率。次要结果是插管成功的时间，术中心动过缓的次数和最低血氧饱和度，黏膜损伤的发生，ETI失败的原因，以及主管和住院医生对ETI相关问题的认识。结果：在第一阶段，34名儿科住院医生使用VL或CL进行了213次ETI。干预组在基线时具有可比性。INVL组插管成功率较高(75.2%比63.4%，P=.03)，插管时间较长(57秒比47秒，P=0.008)。在第二阶段，23名住院医生使用CL进行了55次ETI。居民组使用CL进行ETI的成功率为63%(第一阶段为75%，P=.16)。结论：学习ETI时，使用VL可提高成功率。插管成功的时间较长，但在临床上差异不显著。当改用CL时，居民的成功率略有下降，但不显著。这表明，当转换到CL时，居民保留了一定水平的ETI技能。VL是一种很有前途的新生儿ETI教学工具。
OBJECTIVE: To assess whether the videolaryngoscope (VL) is superior to the classic laryngoscope (CL) in acquiring skill in neonatal endotracheal intubation (ETI) and, once acquired with the VL, whether the skill is transferable to the CL.METHODS: This randomized controlled trial, in a level 3 Canadian hospital, recruited junior pediatric residents who performed ETI in the NICU. The primary outcome was success rate of ETI. Secondary outcomes were time to successful intubation, number of bradycardia episodes andlowest oxygen saturation during procedure, occurrence of mucosal trauma, reason for ETI failure, and recognition of problems related to ETI bysupervisor andresident.RESULTS: In phase 1, 34 pediatric residents performed 213 ETIs by using either VL or CL. Intervention groups were comparable at baseline. The success rate was higher (75.2% vs 63.4%, P = .03), and time to successful intubation was longer, inVL group (57 vs 47 seconds, P = .008). In phase 2, 23 residents performed 55 ETIs using CL. The success rate of residents inVL group performing ETI by using the CL was 63% (compared with 75% in phase 1, P = .16).CONCLUSIONS: When learning ETI, the success rate is improved with the VL. Time to successful intubation is longer, but the difference is not clinically significant. When switched to the CL, residents' success rate slightly decreased, but not significantly. This suggests that residents retain a certain level of ETI skill when switched to the CL. The VL is a promising tool for teaching neonatal ETI.