Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial
Objective To assess whether video laryngoscopy (VL) for tracheal intubation of neonates results in a higher first-attempt success rate and fewer adverse tracheal intubation-associated events (TIAEs) when compared with direct laryngoscopy (DL).Design Single-centre, parallel group, randomised controll...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-12-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/7/1/e001958.full |
| _version_ | 1827394537226502144 |
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| author | André Kidszun Eva Mildenberger Julia Winter Susanne Tippmann Michael Eichinger Janine Schäfer Ann-Kathrin Mühler Katharina Schmitz Mascha Schönfeld |
| author_facet | André Kidszun Eva Mildenberger Julia Winter Susanne Tippmann Michael Eichinger Janine Schäfer Ann-Kathrin Mühler Katharina Schmitz Mascha Schönfeld |
| author_sort | André Kidszun |
| collection | DOAJ |
| description | Objective To assess whether video laryngoscopy (VL) for tracheal intubation of neonates results in a higher first-attempt success rate and fewer adverse tracheal intubation-associated events (TIAEs) when compared with direct laryngoscopy (DL).Design Single-centre, parallel group, randomised controlled trial.Setting University Medical Centre Mainz, Germany.Patients Neonates <440/7 weeks postmenstrual age in whom tracheal intubation was indicated either in the delivery room or in the neonatal intensive care unit.Intervention Intubation encounters were randomly assigned to either VL or DL at first attempt.Primary outcome First-attempt success rate during tracheal intubation.Results Of 121 intubation encounters assessed for eligibility, 32 (26.4%) were either not randomised (acute emergencies (n=9), clinicians’ preference for either VL (n=8) or DL (n=2)) or excluded from the analysis (declined parental consent (n=13)). Eighty-nine intubation encounters (41 in the VL and 48 in the DL group) in 63 patients were analysed. First-attempt success rate was 48.8% (20/41) in the VL group compared with 43.8% (21/48) in the DL group (OR 1.22, 95% CI 0.51 to 2.88).The frequency of adverse TIAEs was 43.9% (18/41) and 47.9% (23/48) in the VL and DL group, respectively (OR 0.85, 95% CI 0.37 to 1.97). Oesophageal intubation with concomitant desaturation never occurred in the VL group but in 18.8% (9/48) of intubation encounters in the DL group.Conclusion This study provides effect sizes for first-attempt success rates and frequency of TIAEs with VL compared with DL in the neonatal emergency setting. This study was underpowered to detect small but clinically important differences between the two techniques. The results of this study may be useful in planning future trials. |
| first_indexed | 2024-03-08T18:14:18Z |
| format | Article |
| id | doaj.art-0f018639196b41b69ba111e42b284a6f |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-03-08T18:14:18Z |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-0f018639196b41b69ba111e42b284a6f2023-12-31T12:40:08ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722023-12-017110.1136/bmjpo-2023-001958Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trialAndré Kidszun0Eva Mildenberger1Julia Winter2Susanne Tippmann3Michael Eichinger4Janine Schäfer5Ann-Kathrin Mühler6Katharina Schmitz7Mascha Schönfeld8Department of Neonatology, University Medical Center, Mainz, GermanyDepartment of Neonatology, University Medical Center, Mainz, GermanyDepartment of Neonatology, University Medical Center, Mainz, GermanyDepartment of Neonatology, University Medical Center, Mainz, GermanyDivision of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Graz, AustriaDepartment of Neonatology, University Medical Center, Mainz, GermanyDepartment of Neonatology, University Medical Center, Mainz, GermanyDepartment of Neonatology, University Medical Center, Mainz, GermanyDepartment of Neonatology, University Medical Center, Mainz, GermanyObjective To assess whether video laryngoscopy (VL) for tracheal intubation of neonates results in a higher first-attempt success rate and fewer adverse tracheal intubation-associated events (TIAEs) when compared with direct laryngoscopy (DL).Design Single-centre, parallel group, randomised controlled trial.Setting University Medical Centre Mainz, Germany.Patients Neonates <440/7 weeks postmenstrual age in whom tracheal intubation was indicated either in the delivery room or in the neonatal intensive care unit.Intervention Intubation encounters were randomly assigned to either VL or DL at first attempt.Primary outcome First-attempt success rate during tracheal intubation.Results Of 121 intubation encounters assessed for eligibility, 32 (26.4%) were either not randomised (acute emergencies (n=9), clinicians’ preference for either VL (n=8) or DL (n=2)) or excluded from the analysis (declined parental consent (n=13)). Eighty-nine intubation encounters (41 in the VL and 48 in the DL group) in 63 patients were analysed. First-attempt success rate was 48.8% (20/41) in the VL group compared with 43.8% (21/48) in the DL group (OR 1.22, 95% CI 0.51 to 2.88).The frequency of adverse TIAEs was 43.9% (18/41) and 47.9% (23/48) in the VL and DL group, respectively (OR 0.85, 95% CI 0.37 to 1.97). Oesophageal intubation with concomitant desaturation never occurred in the VL group but in 18.8% (9/48) of intubation encounters in the DL group.Conclusion This study provides effect sizes for first-attempt success rates and frequency of TIAEs with VL compared with DL in the neonatal emergency setting. This study was underpowered to detect small but clinically important differences between the two techniques. The results of this study may be useful in planning future trials.https://bmjpaedsopen.bmj.com/content/7/1/e001958.full |
| spellingShingle | André Kidszun Eva Mildenberger Julia Winter Susanne Tippmann Michael Eichinger Janine Schäfer Ann-Kathrin Mühler Katharina Schmitz Mascha Schönfeld Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial BMJ Paediatrics Open |
| title | Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial |
| title_full | Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial |
| title_fullStr | Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial |
| title_full_unstemmed | Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial |
| title_short | Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial |
| title_sort | video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting a randomised controlled trial |
| url | https://bmjpaedsopen.bmj.com/content/7/1/e001958.full |
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