Koele-Schmidt Lindsey, Vasquez Margarita M
Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Paediatr Anaesth. 2016 Apr;26(4):392-8. doi: 10.1111/pan.12832. Epub 2015 Dec 30.
Competency rates in neonatal intubation among pediatric residents are low and currently not meeting ACGME/AAP standards.
The aim of this study was to compare standard bedside teaching of neonatal endotracheal intubation to a computer module, as well as introduce residents to the emerging technology of videolaryngoscopy.
The study population consisted of The University of Texas Health Science Center at San Antonio Pediatric interns/residents and PGY-1 Anesthesia interns rotating through the NICU. Prior to participating in the study, the residents completed a survey addressing past experiences with intubation, comfort level, and prior use of direct and videolaryngoscopy. Participants then performed timed trials of both direct and videolaryngoscopy on the SimNewB(®). They had up to three attempts to successfully intubate, with up to 30 s on each attempt. After randomization, participants received one of the following teaching interventions: standard, computer module, or both. This was followed by a second intubation trial and survey completion.
Thirty residents were enrolled in the study. There was significant improvement in time to successful intubation in both methods after any teaching intervention (direct 22.0 ± 13.4 s vs 14.7 ± 5.9 s, P = 0.002 and videolaryngoscopy 42.2 ± 29.3 s vs 26.8 ± 18.6 s, P = 0.003). No differences were found between the types of teaching. Residents were faster at intubating with direct laryngoscopy compared to videolaryngoscopy before and after teaching. By the end of the study, only 33% of residents preferred using videolaryngoscopy over direct laryngoscopy, but 76% felt videolaryngoscopy was better to teach intubation.
Both standard teaching and computer module teaching of neonatal intubation on a mannequin model results in improved time to successful intubation and overall improved resident confidence with intubation equipment and technique. Although intubation times were lower with direct laryngoscopy compared to videolaryngoscopy, the participating residents felt that videolaryngoscopy is an important educational tool.
儿科住院医师新生儿插管的胜任率较低，目前未达到美国研究生医学教育认证委员会/美国儿科学会的标准。
本研究旨在比较新生儿气管插管的标准床边教学与计算机模块教学，并向住院医师介绍新兴的视频喉镜技术。
研究对象包括德克萨斯大学圣安东尼奥健康科学中心的儿科实习生/住院医师以及在新生儿重症监护病房轮转的PGY-1麻醉科实习生。在参与研究之前，住院医师完成了一项关于过去插管经历、舒适度以及直接喉镜和视频喉镜先前使用情况的调查。参与者随后在SimNewB(®)上进行直接喉镜和视频喉镜的定时试验。他们最多有三次成功插管的尝试机会，每次尝试最多30秒。随机分组后，参与者接受以下教学干预之一：标准教学、计算机模块教学或两者皆有。随后进行第二次插管试验并完成调查。
30名住院医师参与了该研究。在任何教学干预后，两种方法成功插管的时间均有显著改善（直接喉镜：22.0 ± 13.4秒对14.7 ± 5.9秒，P = 0.002；视频喉镜：42.2 ± 29.3秒对26.8 ± 18.6秒，P = 0.003）。教学类型之间未发现差异。教学前后，住院医师使用直接喉镜插管比视频喉镜更快。到研究结束时，只有33%的住院医师更喜欢使用视频喉镜而不是直接喉镜，但76%的人认为视频喉镜更适合用于教学插管。
在人体模型上进行新生儿插管的标准教学和计算机模块教学均能缩短成功插管时间，并总体提高住院医师对插管设备和技术的信心。尽管直接喉镜的插管时间比视频喉镜短，但参与研究的住院医师认为视频喉镜是一种重要的教育工具。
