John Giuliano, Jr., MD, FCCM
Associate Professor of Pediatric Critical Care Medicine
Yale University School of Medicine
Disclosure information not submitted.
Ashwin Krishna, MD
Pediatric Intensivist
University of Kentucky College of Medicine, United States
Disclosure information not submitted.
Natalie Napolitano, MPH, MPH, RRT-NPS (she/her/hers)
Research Clinical Specialist
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Josep Panisello, MD
Pediatric Intensivist
Yale School of Medicine, United States
Disclosure information not submitted.
Asha Shenoi, MD, FCCM
Associate Professor
University of Kentucky Albert B Chandler Hospital, United States
Disclosure information not submitted.
Ronald Sanders, MD, MS, FCCM
Professor of Pediatrics
Arkansas Childrens Hospital, United States
Disclosure information not submitted.
Kyle Rehder, MD, CPPS,FCCM
Pediatric Intensivist
Duke University Hospital
Durham, North Carolina, United States
Disclosure information not submitted.
Awni Al-Subu, MD
Associate Professor of Pediatrics
University of Wisconsin Hospital and Clinics
Madison, Wisconsin
Disclosure information not submitted.
Calvin Brown III, MD
Assistant Professor
Brigham and Women's Hospital, Department of Emergency Medicine, United States
Disclosure information not submitted.
Takanari Ikeyama, MD
Attending Physician
Aichi Children's Health and Medical Center, United States
Disclosure information not submitted.
Lauren Edwards, MD
MD
Arkansas Children's Hospital, Arkansas, United States
Disclosure information not submitted.
Lisa Wright, MD
Attending Physician
Baylor College of Medicine Texas Children's Hospital, United States
Disclosure information not submitted.
Matthew Pinto, MD
Assistant Professor
Maria Fareri Children's Hospital At Westchester Medical Center
Valhalla, New York, United States
Disclosure information not submitted.
Ilana Harwayne-Gidansky, MA, MD (she/her/hers)
Associate Professor of Pediatrics
Bernard and Millie Duker Children's Hospital at Albany Medical Center
Albany, NY
Disclosure information not submitted.
Simon Parsons, MD
Attending Physician
Alberta Children's Hospital, United States
Disclosure information not submitted.
Amy Romer, MD
Attending Physician
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
.jpg "Vinay Nadkarni, MD, MS, FCCM (he/him/his) photo")
Vinay Nadkarni, MD, MS, FCCM (he/him/his)
Professor, Anesthesiology, Critical Care and Pediatrics
University of Pennsylvania Perelman School of Medicine, CHOP
Media, Pennsylvania, United States
Disclosure information not submitted.
Akira Nishisaki, MD, MSCE
Associate Professor of Anesthesia and Critical Care Medicine
The Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Title: Implementation of Video Laryngoscopy coaching as a multicenter PICU quality improvement
BACKGROUND/HYPOTHESIS:Tracheal intubation (TI) is a high-risk procedure for critically ill children with frequent adverse tracheal intubation associated events (TIAEs) and peri-intubation hypoxemia. Adult and pediatric studies evaluating the effectiveness of video laryngoscopy (VL) show conflicting results. We hypothesize that routine use of VL as a coaching device would reduce TIAEs and hypoxemia across multiple PICUs.
Method: VL coaching practice was implemented across 10 PICUs in US and Canada between 2016-2020. Laryngoscopist uses a video laryngoscope as a direct laryngoscope (DL) with a screen image available for a supervising clinician. Supervising clinician coaches the laryngoscopist with standardized coaching language. Primary and secondary outcomes were adverse TIAEs (primary), severe peri-intubation hypoxemia (SpO2< 80%) and first attempt success (secondary). Effect of VL implementation was evaluated by multivariable logistic regression with generalized estimating equations to account for site clustering and covariates.
Results: Of 5,060 primary TIs, VL was utilized in 3,580 (71%). VL increased from 45% in 2016 to 93% in 2020 (p< 0.001). VL was used more often in older children (infant 66%, young child:1-7y 71%, older child: 8-17 yr 75%, adult>18 yr 76%, p< 0.001), and more in children with history of difficult airway (difficult airway history 82% vs. without 77%, p< 0.001). In univariate analyses, VL was associated with lower adverse TIAE (VL 9.4% vs DL 14.5%, p< 0.001), but not with severe hypoxemia (VL 15.7% vs. DL 16.4%, p=0.58). After controlling for patient age, TI indication, difficult airway history and clinical features, medication, provider training level, apneic oxygenation use, and site clustering, VL was significantly associated with lower TIAE rate: aOR 0.65, 95%CI 0.49-0.86, p=0.003, but not with severe hypoxemia: aOR 0.95 95%CI 0.73-1.25, p=0.734. VL was not significantly associated with higher first attempt success: aOR 1.21 95% CI 0.98-1.50, p=0.079.
Conclusions: VL coaching implementation achieved a high level of adherence across the PICU. VL use reduced adverse TIAEs but it did not reduce peri-intubation hypoxemia.
Funding disclosure:This study was supported by AHRQ R18HS024511