Teaching fiberoptic-assisted tracheoscopy in very low birth weight infants: A randomized controlled simulator study

Area of Science:

• Neonatal Medicine
• Medical Education
• Endoscopic Procedures

Background:

• Direct laryngoscopy can be challenging during surfactant replacement therapy in neonates.
• Fiberoptic-assisted tracheoscopy (FAST) offers an alternative to minimize airway trauma.
• Standardized training methods are crucial for mastering new endoscopic techniques.

Purpose of the Study:

• To evaluate the efficacy of Peyton's Four-Step Approach for training fiberoptic-assisted tracheoscopy (FAST).
• To compare FAST performance between novices trained with Peyton's method versus standard bedside teaching.
• To assess the impact of training on FAST completion time and success rate in a simulated VLBW infant model.

Main Methods:

• A prospective randomized controlled study was conducted with 186 physicians, trainees, students, and nurses.
• Participants were randomly assigned to either Peyton's Four-Step Approach group or a standard bedside teaching control group.
• Primary endpoints included total and component times for bronchoscope placement and method success rate.

Main Results:

• The Peyton group demonstrated significantly faster FAST completion times (33.2 ± 27.5 s) compared to the control group (79.5 ± 47.9 s).
• The FAST success rate was higher in the Peyton group (95%) than in the control group (84%).
• Novices, after standardized training, achieved a high success rate in completing FAST.

Conclusions:

• Peyton's Four-Step Approach is a superior training method for fiberoptic-assisted tracheoscopy in neonates.
• This training strategy enhances both the speed and success of FAST performance.
• Effective training is essential for novices to successfully perform advanced endoscopic procedures like FAST.