Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU*-Reference-Cited by-同舟云学术

Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU*

Published:2023-03-27 Issue:7 Volume:51 Page:936-947
ISSN:0090-3493
Container-title:Critical Care Medicine
language:en
Short-container-title:

Author:

Giuliano John¹,Krishna Ashwin²,Napolitano Natalie³,Panisello Josep⁴,Shenoi Asha⁵,Sanders Ronald C.⁶,Rehder Kyle⁷,Al-Subu Awni⁸,Brown Calvin⁹,Edwards Lauren¹⁰,Wright Lisa⁵,Pinto Matthew¹¹,Harwayne-Gidansky Ilana¹²,Parsons Simon¹³,Romer Amy¹⁴,Laverriere Elizabeth¹⁵,Shults Justine¹⁶,Yamada Nicole K.¹⁷,Walsh Catharine M.¹⁸,Nadkarni Vinay¹⁹,Nishisaki Akira¹⁹,

Affiliation:

1. Department of Pediatrics, Section of Pediatric Critical Care Medicine, Yale University School of Medicine, New Haven, CT.

2. Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Kentucky College of Medicine, Lexington, KY.

3. Respiratory Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA.

4. Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT.

5. Department of Pediatrics and Critical Care Medicine, University of Kentucky College of Medicine, Kentucky Children’s Hospital, Lexington, KY.

6. Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.

7. Division of Pediatric Critical Care, Duke Children’s Hospital, Durham, NC.

8. Division of Pediatric Critical Care Medicine, Department of Pediatrics, UW Health American Family Children’s Hospital, University of Wisconsin-Madison, Madison, WI.

9. Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.

10. Section of Critical Care, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, AR.

11. Pediatric Critical Care Medicine, Department of Pediatrics, Maria Fareri Children’s Hospital, Valhalla, NY.

12. Department of Pediatrics, Bernard and Millie Duker Children’s Hospital at Albany Medical Center, Albany, NY.

13. Division of Critical Care, Alberta Children’s Hospital, Calgary, AB, Canada.

14. Division of Cardiac Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA.

15. Division of Critical Care Medicine and Division of General Anesthesiology at Children’s Hospital of Philadelphia, Philadelphia, PA.

16. Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

17. Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.

18. Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, ON, Canada.

19. Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Abstract

Objectives: To evaluate implementation of a video laryngoscope (VL) as a coaching device to reduce adverse tracheal intubation associated events (TIAEs). Design: Prospective multicenter interventional quality improvement study. Setting: Ten PICUs in North America. Patients: Patients undergoing tracheal intubation in the PICU. Interventions: VLs were implemented as coaching devices with standardized coaching language between 2016 and 2020. Laryngoscopists were encouraged to perform direct laryngoscopy with video images only available in real-time for experienced supervising clinician-coaches. Measurements and Main Results: The primary outcome was TIAEs. Secondary outcomes included severe TIAEs, severe hypoxemia (oxygen saturation < 80%), and first attempt success. Of 5,060 tracheal intubations, a VL was used in 3,580 (71%). VL use increased from baseline (29.7%) to implementation phase (89.4%; p < 0.001). VL use was associated with lower TIAEs (VL 336/3,580 [9.4%] vs standard laryngoscope [SL] 215/1,480 [14.5%]; absolute difference, 5.1%; 95% CI, 3.1–7.2%; p < 0.001). VL use was associated with lower severe TIAE rate (VL 3.9% vs SL 5.3%; p = 0.024), but not associated with a reduction in severe hypoxemia (VL 15.7% vs SL 16.4%; p = 0.58). VL use was associated with higher first attempt success (VL 71.8% vs SL 66.6%; p < 0.001). In the primary analysis after adjusting for site clustering, VL use was associated with lower adverse TIAEs (odds ratio [OR], 0.61; 95% CI, 0.46–0.81; p = 0.001). In secondary analyses, VL use was not significantly associated with severe TIAEs (OR, 0.72; 95% CI, 0.44–1.19; p = 0.20), severe hypoxemia (OR, 0.95; 95% CI, 0.73–1.25; p = 0.734), or first attempt success (OR, 1.28; 95% CI, 0.98–1.67; p = 0.073). After further controlling for patient and provider characteristics, VL use was independently associated with a lower TIAE rate (adjusted OR, 0.65; 95% CI, 0.49–0.86; p = 0.003). Conclusions: Implementation of VL-assisted coaching achieved a high level of adherence across the PICUs. VL use was associated with reduced adverse TIAEs.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine

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