Patient Monitor Position and Operator Ability to Visualize a Desaturation Event During Intubation

Area of Science:

• Medical Simulation
• Patient Safety
• Emergency Medicine

Background:

• Endotracheal intubation equipment setup often places patient monitors behind the operator.
• This suboptimal monitor placement can delay the recognition of critical desaturation events.

Purpose of the Study:

• To evaluate the association between patient monitor position and the time to recognize desaturation during simulated endotracheal intubation.
• To compare monitor positions (head, left, right) and their impact on hypoxia detection.

Main Methods:

• Randomized crossover trial involving emergency medicine residents on a difficult airway trainer.
• Monitored peripheral capillary oxygen saturation (SpO2) decrease; primary outcome was time to hypoxia recognition (<90% SpO2).
• Analyzed data using Kaplan-Meier curves, Cox regression, and multivariable linear regression.

Main Results:

• Median hypoxia recognition times were 37s (head), 32s (left), and 23s (right).
• Monitor placement to the left or right of the bed significantly decreased hypoxia recognition time compared to the head (P=.04, P=.03).
• No significant association found between recognition time and laryngoscopy modality or operator experience.

Conclusions:

• Patient monitor position significantly impacts the timeliness of desaturation recognition during simulated intubation.
• Positioning the monitor to the side, within the operator's view, is recommended for improved patient safety.
• Further research should explore equipment setup's impact on procedural performance and ergonomics.