Multicenter Study

. 2023 Jul 1;51(7):936-947.

doi: 10.1097/CCM.0000000000005847. Epub 2023 Mar 27.

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

John Giuliano Jr¹, Ashwin Krishna², Natalie Napolitano³, Josep Panisello⁴, Asha Shenoi⁵, Ronald C Sanders Jr⁶, Kyle Rehder⁷, Awni Al-Subu⁸, Calvin Brown 3rd⁹, Lauren Edwards¹⁰, Lisa Wright⁵, Matthew Pinto¹¹, Ilana Harwayne-Gidansky¹², Simon Parsons¹³, Amy Romer¹⁴, Elizabeth Laverriere¹⁵, Justine Shults¹⁶, Nicole K Yamada¹⁷, Catharine M Walsh¹⁸, Vinay Nadkarni¹⁹, Akira Nishisaki¹⁹; National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Affiliations

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.

PMID: 37058348
DOI: 10.1097/CCM.0000000000005847

Multicenter Study

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

John Giuliano Jr et al. Crit Care Med. 2023.

. 2023 Jul 1;51(7):936-947.

doi: 10.1097/CCM.0000000000005847. Epub 2023 Mar 27.

Authors

Affiliations

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.

PMID: 37058348
DOI: 10.1097/CCM.0000000000005847

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.

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Conflict of interest statement

Ms. Napolitano’s, Dr. Shults’s, Dr. Nadkarni’s, and Dr. Nishisaki’s institutions received funding from the Agency for Healthcare Research and Quality (AHRQ) (R18HS024511). Ms. Napolitano’s institution received funding from Drager, Timpel, Philips/Respironics, Actuated Medical, and VERO-Biotech. Dr. Parsons institution received funding from Children’s Hospital of Philadelphia (CHOP) National Emergency Airway Registry for Children. Dr. Shults received support for article research from the AHRQ (R18HS024511). Dr. Yamada’s institution received funding from the AHRQ. Dr. Nishisaki’s institution received funding from Chiesi; she received funding from CHOP; and she received support for article research from the AHRQ. Dr. Nadkarni was supported by the Endowed Chair, Critical Care Medicine, and CHOP. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

1. Nishisaki A, Turner DA, Brown CA 3rd, et al.; National Emergency Airway Registry for Children (NEAR4KIDS); Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: A national emergency airway registry for children: Landscape of tracheal intubation in 15 PICUs. Crit Care Med. 2013; 41:874–885
1. Shiima Y, Berg RA, Bogner HR, et al.; National Emergency Airway Registry for Children Investigators; National Emergency Airway Registry for Children Investigators: Cardiac arrests associated with tracheal intubations in PICUs: A multicenter cohort study. Crit Care Med. 2016; 44:1675–1682
1. Li S, Hsieh TC, Rehder KJ, et al.; for National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network; for National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: Frequency of desaturation and association with hemodynamic adverse events during tracheal intubations in PICUs. Pediatr Crit Care Med. 2018; 19:e41–e50
1. Schmidt SK, Brou L, Deakyne SJ, et al.: Frequency and characterization of tracheal intubation adverse events in pediatric sepsis. Pediatr Crit Care Med. 2018; 19:e80–e87
1. Parker MM, Nuthall G, Brown C 3rd, et al.; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network: Relationship between adverse tracheal intubation associated events and PICU outcomes. Pediatr Crit Care Med. 2017; 18:310–318

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources