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Association between video laryngoscopy characteristics and successful neonatal tracheal intubation: a prospective study
  1. William Corder1,
  2. Timothy Nelin1,
  3. Anne M Ades1,
  4. John Flibotte1,
  5. Elizabeth Laverriere2,
  6. Rodrigo Daly Guris2,
  7. Leane Soorikian3,
  8. Elizabeth E Foglia1
  1. 1Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  3. 3Respiratory Therapy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr William Corder, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA; corderw{at}chop.edu

Abstract

Objective To identify associations between procedural characteristics and success of neonatal tracheal intubation (NTI) using video laryngoscopy (VL).

Design Prospective single-centre observational study.

Setting Quaternary neonatal intensive care unit.

Patients Infants requiring NTI at the Children’s Hospital of Philadelphia.

Interventions VL NTI recordings were evaluated to assess 11 observable procedural characteristics hypothesised to be associated with VL NTI success. These characteristics included measures of procedural time and performance, glottic exposure and position, and laryngoscope blade tip location.

Main outcome measure VL NTI attempt success.

Results A total of 109 patients underwent 109 intubation encounters with 164 intubation attempts. The first attempt success rate was 65%, and the overall encounter success rate was 100%. Successful VL NTI attempts were associated with shorter procedural duration (36 s vs 60 s, p<0.001) and improved Cormack-Lehane grade (63% grade I vs 49% grade II, p<0.001) compared with unsuccessful NTIs. Other factors more common in successful NTI attempts than unsuccessful attempts were laryngoscope blade placement to lift the epiglottis (45% vs 29%, p=0.002), fewer tracheal tube manoeuvres (3 vs 8, p<0.001) and a left-sided or non-visualised tongue location (76% vs 56%, p=0.009).

Conclusion We identified procedural characteristics visible on the VL screen that are associated with NTI procedural success. Study results may improve how VL is used to teach and perform neonatal intubation.

  • intensive care units
  • intensive care units, neonatal
  • neonatology
  • paediatrics
  • resuscitation

Data availability statement

Data are available on reasonable request. De-identified data (individual participant data, study protocol, statistical analysis plan) that underlie the results reported in this article are available immediately after publication and ending 36 months after article publication to researchers who provide a methodologically sound proposal in order to achieve aims in an approved proposal. Proposals should be directed to corderw@chop.edu. After 36 months, the data will be available in our university’s data warehouse but without investigator support other than deposited metadata.

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Data availability statement

Data are available on reasonable request. De-identified data (individual participant data, study protocol, statistical analysis plan) that underlie the results reported in this article are available immediately after publication and ending 36 months after article publication to researchers who provide a methodologically sound proposal in order to achieve aims in an approved proposal. Proposals should be directed to corderw@chop.edu. After 36 months, the data will be available in our university’s data warehouse but without investigator support other than deposited metadata.

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Footnotes

  • X @wilcorder

  • Contributors WC: guarantor, writing—review and editing, writing—original draft, resources, methodology, investigation, formal analysis, data curation, conceptualisation. TN: writing—review and editing, validation, formal analysis. AMA: writing—review and editing, conceptualisation. JF: writing—review and editing, conceptualisation. EL: writing—review and editing, conceptualisation. RDG: writing—review and editing, conceptualisation. LS: writing—review and editing, data curation. EEF: writing—review and editing, supervision, resources, methodology, formal analysis, data curation, conceptualisation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.