Abstract
Objectives: The use of video laryngoscopy (VL) may augment emergency pediatric intubations outside the operating room (OR). Our objective was to describe the proportion of use and complications with VL before and after implementation of a VL just-in-time training (JITT).Study design: This study was a retrospective chart review of pediatric intubations performed outside the OR at a single women and children’s hospital from January 2015 to March 2020. Data were collected on patient age, intubation method, operator characteristics, adverse events, number of attempts, condition leading to intubation, and hospital location. Data were separated into pre-JITT (January 1, 2015 to April 31, 2018) and post-JITT (May 1, 2018 to March 1, 2020) periods. Descriptive statistics were used comparing pre- and post-JITT periods for VL use, and the complications of intubations with multiple attempts (IMAs) and intubations with one or more adverse events (AEs).Results: A total of 231 pediatric patients were intubated during the study period; 154 intubations in the pre-JITT and 77 intubations in the post-JITT periods. Pre- and post-JITT VL use was 17 (11%) and 17 (22%), respectively. With pre-JITT VL, there were four (23%) IMAs and zero (0%) intubation with one or more AE. With post-JITT VL, there were eight (47%) IMAs and one (6%) intubation with one or more AE.Conclusion: The proportion of emergency pediatric intubations using VL increased after the institution of a JITT. There was no significant change in IMAs and AEs. The infrequency of pediatric intubations makes drawing conclusions regarding the impact on IMAs and AEs challenging. JITT may increase VL use for emergency pediatric intubations outside the OR and may be considered for refresher training, especially during the coronavirus disease 2019 (COVID-19) pandemic.
Highlights
Ill and injured pediatric patients frequently require intubation during the course of their medical care
The proportion of emergency pediatric intubations using video laryngoscopy (VL) increased after the institution of a just-in-time training (JITT)
There was no significant change in intubations with multiple attempts (IMAs) and adverse events (AEs)
Summary
Ill and injured pediatric patients frequently require intubation during the course of their medical care. Pediatric patients have a higher metabolic rate, less reserve, and faster onset of hypoxia, making first-pass intubation success an even more critical goal than with adult patients [1,2]. Use of VL over DL for intubation is recommended to minimize risk by increasing first attempt success and distance from the patient’s airway during this potentially aerosol-generating procedure [3,4]. While VL in adults may reduce the number of failed intubations, improve the glottic view, and reduce laryngeal trauma, in children, some evidence suggests that VL may lead to prolonged intubation with an increased rate of intubation failure when compared to DL [5,6]. In light of the coronavirus disease 2019 (COVID-19) pandemic, the need to upskill medical providers in the use of VL has become evident
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