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Noninvasive Intratracheal Intubation to Study the Pathology and Physiology of Mouse Lung
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Intubating extremely premature newborns: a randomised crossover simulation study.

Joseph O'Connell1, Gary Weiner1

  • 1Division of Neonatal-Perinatal Medicine, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA.

BMJ Paediatrics Open
|April 12, 2018
PubMed
Summary
This summary is machine-generated.

Neither size-0 nor size-00 Miller laryngoscope blades improved tracheal intubation success in extremely low birthweight neonates. Blade design variations between manufacturers impacted outcomes, not size preference.

Keywords:
intubationlaryngoscopyneonatal resuscitationnewborn

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Area of Science:

  • Neonatal Medicine
  • Pediatric Critical Care
  • Medical Simulation

Background:

  • Tracheal intubation is a critical procedure for extremely low birthweight (ELBW) neonates.
  • Choosing the correct laryngoscope blade size is essential for successful intubation.
  • Current recommendations offer flexibility in blade selection for ELBW infants.

Purpose of the Study:

  • To compare the success rates of size-0 and size-00 Miller laryngoscope blades for tracheal intubation in ELBW neonates.
  • To evaluate the impact of blade size and manufacturer on intubation time and first-attempt success.
  • To assess healthcare providers' preferences for laryngoscope blade size.

Main Methods:

  • A randomized crossover simulation study was conducted in a simulated neonatal intensive care unit.
  • Fifty-five neonatology physicians and nurse practitioners performed simulated intubations on an ELBW manikin.
  • Participants used size-0 and size-00 Miller blades from two manufacturers, with intubation time and success recorded.

Main Results:

  • No significant difference was found in total laryngoscopy time or first-attempt success (<30 seconds) between size-0 and size-00 Miller blades.
  • Significant differences in outcomes were observed between blades of the same size but from different manufacturers.
  • Provider preference for blade size did not influence intubation success rates.

Conclusions:

  • The study supports the optional use of the size-00 blade for ELBW neonates, as per Neonatal Resuscitation Program guidelines.
  • Awareness of manufacturer-specific design variations in laryngoscope blades is crucial for operators.
  • Just-in-time training with manikins may enhance intubation performance in real-world scenarios.