The online version of this article (https://doi.org/10.1186/s13052-017-0435-z) contains supplementary material, which is available to authorized users.
In neonatal endotracheal intubation, excessive pressure on soft tissues during laryngoscopy can determine permanent injury. Low-fidelity skill trainers do not give valid feedback about this issue. This study describes the technical realization and validation of an active neonatal intubation skill trainer providing objective feedback.
We studied expert health professionals’ performances in neonatal intubation, underlining chance for procedure retraining. We identified the most critical points in epiglottis and dental arches and fixed commercial force sensors on chosen points on a ©Laerdal Neonatal Intubation Trainer. Our skill trainer was set up as a grade 3 on Cormack and Lehane’s scale, i.e. a model of difficult intubation. An associated software provided real time sound feedback if pressure during laryngoscopy exceeded an established threshold. Pressure data were recorded in a database, for subsequent analysis with non-parametric statistical tests. We organized our study in two intubation sessions (5 attempts each one) for everyone of our participants, held 24 h apart. Between the two sessions, a debriefing phase took place. In addition, we gave our participants two interview, one at the beginning and one at the end of the study, to get information about our subjects and to have feedback about our design.
We obtained statistical significant differences between consecutive attempts, with evidence of learning trends. Pressure on critical points was significantly lower during the second session (p < 0.0001). Epiglottis’ sensor was the most stressed (p < 0.000001). We found a significant correlation between time spent for each attempt and pressures applied to the airways in the two sessions, more significant in the second one (shorter attempts with less pressure, rs = 0.603).
Our skill trainer represents a reliable model of difficult intubation. Our results show its potential to optimize procedures related to the control of trauma risk and to improve personnel retraining.
Additional file 1: Figure S1. A. epiglottis’ force sensor allocation on skill trainer. B. ©LabVIEW graphic interface. For force sensors: green - “untouched sensor”, yellow - “under-threshold touched sensor”, red - “over-threshold touched sensor”. For head position: green - sniffing position, red - inappropriate hyperextension. To the red status are associated two different acoustic alarms. (TIFF 468 kb)13052_2017_435_MOESM1_ESM.tif
Additional file 2: Table S2. Mean times of operators scheduled for attempts in two session. (DOCX 12 kb)13052_2017_435_MOESM2_ESM.docx
Additional file 3: Table S3. Mean pressure values scheduled for attempts in two session. We considered data with outliers exclusion. (DOCX 13 kb)13052_2017_435_MOESM3_ESM.docx
Kattwinkel J. Textbook of Neonatal Resuscitation, 6th Edition: 2010 American Academy of Pediatrics and American Heart Association Guidelines for Neonatal Resuscitation. 2011.
Seow WK, Brown JP, Tudehope DI, O'Callaghan M. Developmental defects in the primary dentition of low birth-weight infants: adverse effects of laryngoscopy and prolonged endotracheal intubation. Pediatr Dent. 1984;6(1):28–31. PubMed
Angelos GM, Smith DR, Jorgenson R, Sweeney EA. Oral complications associated with neonatal oral tracheal intubation: a critical review. Pediatr Dent. 1989;11(2):133–40. PubMed
SIAARTI. Task force: SIAARTI GUIDELINES: recommendations for airway control and difficult airway management in paediatric patients. Minerva Anestesiol. 2006;72:723–48.
Fletcher G, Flin R, McGeorge P, Glavin R, Maran N, Patey R. Rating non-technical skills: developing a behavioural marker system for use in anaesthesia. Cogn Tech Work. 2004;6:165–71. CrossRef
Gaba DM, Howard SK, Fish KJ, Smith BE, Sowb YA. Simulation-based training in anesthesia crisis resource management (ACRM): a decade of experience. Simulation & Gaming. 2001;32(2):175–93. CrossRef
FSR Integration guide. Interlink Electronics Website. https://cdn2.hubspot.net/hubfs/3899023/Interlinkelectronics%20November2017/Docs/Datasheet_FSR.pdf. Accessed 8 Feb 2016.
Tognarelli S, Baldoli I, Scaramuzzo RT, Ciantelli M, Cecchi F, Gentile M, et al. Development and validation of a sensorized neonatal intubation skill trainer for simulation based education enhancement. Int J Med Res Health Sci. 2014;3(4):833–9. CrossRef
Noh Y, Wang C, Tokumoto M, Jorge S, Ishii H, Takanishi A, Shoji S. Development of Airway Management training system WKA-4: Provide useful feedback of trainee performance to trainee during Airway Management. In 2012 ICME International Conference on Complex Medical Engineering, CME 2012 Proceedings. pp. 423–428. . https://doi.org/10.1109/ICCME.2012.6275605.
Nakanishi T, Shiga T, Homma Y, Koyama Y, Goto T. Comparison of the force applied on oral structures during intubation attempts by novice physicians between the Macintosh direct laryngoscope, airway scope and C-MAC PM: a high-fidelity simulator-based study. BMJ Open. 2016;6(5):e011039. PubMedPubMedCentralCrossRef
- Technical realization of a sensorized neonatal intubation skill trainer for operators’ retraining and a pilot study for its validation
Rosa T. Scaramuzzo
- BioMed Central