학술논문
Implementation of Video Laryngoscope-Assisted Coaching Reduces Adverse Tracheal Intubation-Associated Events in the PICU*
Document Type
Academic Journal
Author
Giuliano, John, Jr; Krishna, Ashwin; Napolitano, Natalie; Panisello, Josep; Shenoi, Asha; Sanders, Ronald C., Jr; Rehder, Kyle; Al-Subu, Awni; Brown, Calvin, III; Edwards, Lauren; Wright, Lisa; Pinto, Matthew; Harwayne-Gidansky, Ilana; Parsons, Simon; Romer, Amy; Laverriere, Elizabeth; Shults, Justine; Yamada, Nicole K.; Walsh, Catharine M.; Nadkarni, Vinay; Nishisaki, Akira
Source
Critical Care Medicine. Jul 01, 2023 51(7):936-947
Subject
Language
English
ISSN
0090-3493
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.