A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.
A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.
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DOI：
10.1111/pan.14505
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发表时间：
2022-09
期刊：
影响因子：
--
通讯作者：
Nishisaki A
中科院分区：
文献类型：
--
作者：
Laverriere EK;Fiadjoe JE;McGowan N;Bruins BB;Napolitano N;Watanabe I;Yamada NK;Walsh CM;Berg RA;Nadkarni VM;Nishisaki A
关于在手术室外对儿科患者使用视频喉镜的数据有限。我们的主要目的是评估实施视频喉镜引导指导气管插管是否可行，是否具有较高的依从性，并与减少气管插管相关不良事件相关。这是一项在单中心儿科重症监护室使用标准化指导语言进行视频喉镜气管插管的前后观察性研究。作为实践改进的一部分，使用视频喉镜作为具有标准化指导语言的指导设备。2016年1月至2017年12月期间，儿科重症监护室的所有患者均接受了视频喉镜或直接喉镜下的初次气管插管。测量实施的吸收、持续依从性、气管插管结局（包括所有不良气管插管相关事件）、血氧饱和度下降（<80%SpO2）和首次尝试成功率。在580例气管插管中，284例（49%）在实施前阶段进行，296例（51%）在实施后进行。使用视频喉镜和标准化指导语言的依从性很高（实施后为74%）且持续。两个阶段的气管插管相关不良事件无统计学显著差异（治疗前9%与治疗后5%，绝对差异-3%，CI 95：-8%至1%，p = 0.11），氧去饱和度<80%（术前13% vs.术后13%，绝对差异1%，CI 95 - 6%至5%，p = 0.75），或首次尝试成功（治疗前73% vs.治疗后76%，绝对差异4%，CI 95 - 3%至11%，p = 0.29）。当使用视频喉镜进行气管插管时，主管更可能使用标准化指导语言，而不是标准直接喉镜（80% vs. 43%，绝对差异37%，CI 95 23%至51%，p < 0.001）。视频喉镜作为一种具有标准化指导语言的监督设备的实施是可行的，具有高水平的依从性，但与任何不良气管插管相关事件和氧饱和度下降的发生率增加无关。
There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room. Our primary aim is to evaluate whether implementation of video laryngoscopy guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events. This is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation-associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured. Among 580 tracheal intubations, 284 (49%) were performed during the pre-implementation phase, and 296 (51%) post-implementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% post-implementation) and sustained. There were no statistically significant differences in adverse tracheal intubation-associated events between the two phases (pre- 9% vs. post- 5%, absolute difference −3%, CI95: −8% to 1%, p = 0.11), oxygen desaturations <80% (pre- 13% vs. post- 13%, absolute difference 1%, CI95 −6% to 5%, p = 0.75), or first attempt success (pre- 73% vs. post- 76%, absolute difference 4%, CI95 −3% to 11%, p = 0.29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI95 23% to 51%, p < 0.001). Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.
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影响因子：
8
作者：
Moussa, Ahmed;Luangxay, Yvon;Lachance, Christian
通讯作者：
Lachance, Christian
影响因子：
8.8
作者：
Nishisaki, Akira;Lee, Anthony;Nadkarni, Vinay
通讯作者：
Nadkarni, Vinay
影响因子：
6.2
作者：
Donoghue, Aaron J.;Ades, Anne M.;Deutsch, Ellen S.
通讯作者：
Deutsch, Ellen S.
影响因子：
4.1
作者：
Grunwell, Jocelyn R.;Kamat, Pradip P.;Nishisaki, Akira
通讯作者：
Nishisaki, Akira
影响因子：
4.1
作者：
Nishisaki, Akira;Ferry, Susan;Nadkarni, Vinay M.
通讯作者：
Nadkarni, Vinay M.