Supervisor instruction during neonatal intubation using video laryngoscopy: an observational study

Area of Science:

• Medical Education
• Pediatric Critical Care
• Airway Management

Background:

• Direct laryngoscopy (DL) relies on operator feedback for intubation guidance.
• Video laryngoscopy (VL) allows supervisors to share the operator's view, potentially improving guidance.
• The study investigates supervisor instructions during neonatal VL intubation.

Purpose of the Study:

• To analyze supervisor instructions during neonatal video laryngoscopy (VL) intubation.
• To assess if these instructions effectively prompted desired operator actions.
• To identify areas for improving communication in neonatal intubation supervision.

Main Methods:

• Review of video recordings of neonatal intubations using VL.
• Synchronization of airway views with external video and audio recordings.
• Thematic analysis of supervisor instructions and assessment of their effectiveness.

Main Results:

• Analysis of 59 intubation attempts and 158 supervisor instructions.
• Identified themes: blade positioning, landmark identification, airway alignment, tube introduction, and general guidance.
• Only 47% of instructions prompted intended actions, with clarity issues noted, especially for the lift maneuver. A proforma was developed.

Conclusions:

• Supervisor instructions in neonatal VL intubation frequently lack precision and clarity.
• Fewer than half of instructions led to desired actions, highlighting a need for improved communication.
• Enhanced communication strategies are essential for optimizing neonatal intubation success with VL.