Does Coaching Make Pediatric Airway Safer?

June 1, 2023

Written by Rebecca White

Spoon Feed
Implementation of video laryngoscope (VL) assisted coaching for intubation in the pediatric intensive care unit (PICU) was associated with reduced intubation-associated adverse events.

Why does this matter?
Pediatric intubation remains a low-frequency, high-risk procedure; intubation of critically ill children is often associated with adverse events, which puts them at risk of poor overall outcomes. VL has previously shown benefits in pediatric ED intubations, discussed here! VL is not currently the standard of care in the PICU… but should it be?

A candid camera
This multicenter prospective interventional quality improvement study took place in ten PICUs in North America between 2016 and 2020. To provide opportunities for development of direct laryngoscopy (DL) skills, trainees were instructed to use the VL with standard geometry blades to obtain a direct view of the airway, while an experienced clinician coached the trainee using the video screen for reference.

Of 5,060 intubations, a VL device was used in 3,580 (71%). VL use increased from 29.7% at baseline to 89.4% (p < 0.001) during the study. Use of VL was associated with lower adverse events compared with DL (336/3580 [9.4%] vs 215/1480 [14.5%], p < 0.001) but was not associated with reduction in severe hypoxemia, SpO2 <80%: (563/3580 [15.7%] vs 242/1480 [16.4%], p = 0.58). VL was initially associated with higher first-pass success rate and lower severe adverse events, but this did not hold after adjusting for site clustering. Of note, laryngoscopy method was not randomly assigned, and adverse events were self-reported.

Source
Implementation of Video Laryngoscope Assisted Coaching Reduces Adverse Tracheal Intubation Associated Events in the PICU. Crit Care Med. 2023 Mar 27. doi: 10.1097/CCM.0000000000005847. Online ahead of print.