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Neonatal-Perinatal Health Care Delivery: Practices and Procedures

Neonatal-Perinatal Health Care Delivery 2: Practices: Monitoring, Devices, Respiratory Care

740 - A prospective study of neonatal intubation procedural technique using video laryngoscopy

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 740
Publication Number: 740.245

William D. Corder, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Timothy D. Nelin, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Anne Ades, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; John Flibotte, Children's Hospital of Philadelphia/ UPenn, Philadelphia, PA, United States; Elizabeth Laverriere, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Rodrigo Daly Guris, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Elizabeth Foglia, Perelman School of Medicine at the University of Pennsylvania, Swarthmore, PA, United States

Presenting Author(s)

William D. Corder, MD (he/him/his)

Neonatal Perinatal Fellow
Childrens Hospital of Philadelphia
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States

Background: Video laryngoscopy (VL) improves neonatal tracheal intubation (NTI) success and safety outcomes. However, the optimal procedural characteristics of NTI assessed on the video laryngoscope view have not been defined.

Objective: To identify NTI characteristics ascertained from VL recordings associated with procedural success.

Design/Methods: We prospectively collected VL recordings obtained during NTI attempts in a single center NICU. Based on expert clinical consensus, we defined 11 procedural characteristics observable with VL recordings that were hypothesized to be associated with NTI success. Characteristics include factors related to procedural time and performance, laryngoscope blade positioning, relative airway position, tongue position, and glottic exposure. Patient, provider, and outcome characteristics were summarized using standard descriptive statistics. We assessed the association between VL procedural characteristics and NTI success using Mann Whitney U-tests and chi-squared tests, with a p-value < 0.05 considered statistically significant.

Results: From 10/1/2021-6/30/2022, there were 66 intubation encounters and 100 intubation attempts recorded in 65 patients (Tables 1 and 2). Of the 66 intubation encounters, the first attempt NTI success rate was 65% and the overall NTI success rate was 100%. Procedural characteristics associated with NTI success are displayed in Table 3. Successful NTIs were associated with shorter total procedural duration (36 sec vs. 61 sec, p<0.001) and an increased proportion of time spent obtaining a view of the vocal cords to time inserting the endotracheal tube (ETT), resulting in a higher view to tube-time ratio (1.6 vs. 0.8, p=0.002) as compared to unsuccessful NTIs. Insertion of the laryngoscope blade to lift the epiglottis resulted in more successful NTIs compared to inserting the blade tip in the vallecula or at the tongue base (p = 0.016). Airway visualization in the middle third of the VL screen, tongue positioned to left or not visualized and fewer ETT maneuvers were associated with successful NTI (p=0.042, p=0.021 and p< 0.001 respectively). Neither the presence of a gastric tube nor suctioning were associated with NTI success.

Conclusion(s): Characteristics of successful NTI include shorter total procedural duration, laryngoscpe blade tip position (lifting the epiglottis), and deliberate vocal cord view optimization before inserting the ETT. These findings may help inform NTI training and best practices.