Videolaryngoscopy Versus Direct Laryngoscopy in Simulated Pediatric Intubation - 20/02/13
, Anne M. Ades, MD a, b, d, Akira Nishisaki, MD, MSCE c, d, Ellen S. Deutsch, MD c, d
Address for correspondence: Aaron J. Donoghue, MD, MSCERésumé |
Study objective |
We determine whether videolaryngoscopy results in a higher prevalence of first-attempt intubation success and improved glottic visualization than direct laryngoscopy when performed by pediatric emergency medicine providers in simulated patients.
Methods |
This was a cross-sectional study at a single institution. Fellows and faculty in pediatric emergency medicine were invited to participate. Each subject performed intubations on 3 simulators (newborn, infant, adult), using a videolaryngoscope; each simulator was intubated by each subject with and without use of video. Primary outcome was first-attempt intubation success; secondary outcome was percentage of glottic opening score (POGO).
Results |
Twenty-six participants performed 156 intubations; complete data were available for 148 intubations. First-attempt success in the neonate was 88%; in the infant, 79%; and in the adult, 60%. In the adult simulator, videolaryngoscopy use showed a first-attempt success in 81% of subjects compared with 39% with direct laryngoscopy (difference 43%; 95% confidence interval [CI] 18% to 67%). There was no difference in first-attempt success rates between videolaryngoscopy and direct laryngoscopy in the newborn or infant simulators. Videolaryngoscopy use led to increased POGO scores in all 3 simulators, with a difference of 25% (95% CI 2% to 48%) in newborn simulators, 23% (95% CI 2% to 48%) in infant simulators, and 42% (95% CI 18% to 66%) in adult simulators.
Conclusion |
Videolaryngoscopy was associated with greater first-attempt success during intubation by pediatric emergency physicians on an adult simulator. POGO score was significantly improved in all 3 simulators with videolaryngoscopy.
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| Supervising editor: Steven M. Green, MD |
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| Author contributions: AJD was responsible for study design, obtaining funding, and conducting study sessions. AJD, AA, and AN were responsible for subject recruitment. All authors were responsible for data collection and review. AJD was responsible for drafting the article, and all authors contributed substantially to its revision. AJD takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was supported by the University of Pennsylvania School of Medicine Educational Research Initiative, the Endowed Chair of Critical Care Medicine of the Children's Hospital of Philadelphia, and Karl Storz Endoscopy–America, Inc. (El Segundo, CA). |
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| Please see page 272 for the Editor's Capsule Summary of this article. |
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| Publication date: Available online October 18, 2012. |
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| A 9FQCQ9W survey is available with each research article published on the Web at www.annemergmed.com. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 61 - N° 3
P. 271-277 - mars 2013 Retour au numéro
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