Related Experiment Video
Updated: Sep 21, 2025
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit
Elizabeth K Laverriere1,2, John E Fiadjoe2, Nancy McGowan3
1Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine|, Philadelphia, Pennsylvania, USA.
Insights
Video laryngoscopy implementation in pediatric intensive care units showed high compliance for tracheal intubation coaching. While feasible, it did not significantly reduce adverse events or improve first-attempt success rates.
Area of Science:
- Pediatric Critical Care Medicine
- Airway Management
- Medical Device Implementation
Background:
- Limited data exists on video laryngoscopy use in pediatric patients outside the operating room.
- Assessing the feasibility and impact of video laryngoscopy-guided coaching for tracheal intubation in a pediatric intensive care unit (PICU) setting is crucial.
Purpose of the Study:
- To evaluate the feasibility and compliance of implementing video laryngoscopy-guided coaching for tracheal intubation in a PICU.
- To determine if this implementation reduces adverse tracheal intubation-associated events.
Main Methods:
- A pre-post observational study was conducted in a single-center PICU.
- Video laryngoscopy with standardized coaching language was implemented for tracheal intubation.
- Outcomes measured included compliance, adverse events, oxygen desaturations, and first-attempt success for 580 intubations between January 2016 and December 2017.
Main Results:
- High compliance (74%) for video laryngoscopy use with coaching was achieved and sustained.
- No significant differences were found in adverse events (9% vs. 5%), oxygen desaturations (<80% SpO2) (13% vs. 13%), or first-attempt success (73% vs. 76%) between pre- and post-implementation phases.
- Supervisors were significantly more likely to use standardized coaching language with video laryngoscopy (80%) compared to direct laryngoscopy (43%).
Conclusions:
- Implementing video laryngoscopy as a coaching device with standardized language in a PICU is feasible with high adherence.
- This implementation was not associated with an increase in adverse tracheal intubation events or oxygen desaturation.
- While not directly improving outcomes in this study, video laryngoscopy facilitated the use of standardized coaching language.
Background:
There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room.
Aim:
Our primary aim was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events.
Methods:
This is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation-associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured.
Results:
Among 580 tracheal intubations, 284 (49%) were performed during the preimplementation phase, and 296 (51%) postimplementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% postimplementation) and sustained. There were no statistically significant differences in adverse tracheal intubation-associated events between the two phases (pre- 9% vs. post- 5%, absolute difference -3%, CI95 : -8% to 1%, p = .11), oxygen desaturations <80% (pre- 13% vs. post- 13%, absolute difference 1%, CI95 : -6% to 5%, p = .75), or first attempt success (pre- 73% vs. post- 76%, absolute difference 4%, CI95 : -3% to 11%, p = .29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI95 : 23% to 51%, p < .001).
Conclusions:
Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.
Related Concept Videos
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
01:26Tracheostomy Suctioning I: Pre-Procedural Steps
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...