Abstract
How and when the forces are applied during neonatal intubation are currently unknown. This study investigated the pattern of the applied forces by using sensorized laryngoscopes during the intubation process in a neonatal manikin. Nine users of direct laryngoscope and nine users of straight-blade video laryngoscope were included in a neonatal manikin study. During each procedure, relevant forces were measured using a force epiglottis sensor that was placed on the distal surface of the blade. The pattern of the applied forces could be divided into three sections. With the direct laryngoscope, the first section showed either a quick rise of the force or a discontinuous rise with several peaks; after reaching the maximum force, there was a sort of plateau followed by a quick drop of the applied forces. With the video laryngoscope, the first section showed a quick rise of the force; after reaching the maximum force, there was an irregular and heterogeneous plateau, followed by heterogeneous decreases of the applied forces. Moreover, less forces were recorded when using the video laryngoscope.
Conclusions: This neonatal manikin study identified three sections in the diagram of the forces applied during intubation, which likely mirrored the three main phases of intubation. Overall, the pattern of each section showed some differences in relation to the laryngoscope (direct or video) that was used during the procedure. These findings may provide useful insights for improving the understanding of the procedure.
Key Points
- Phases of Intubation: Intubation involves three phases—laryngoscope insertion, alignment of soft structures for vocal cord visualization, and laryngoscope removal after tube placement.
- Force Patterns: Forces applied during intubation exhibit a triphasic pattern—initial increase, plateau during alignment, and decrease during removal.
- Direct vs. Video Laryngoscopy: Direct Laryngoscope: Associated with higher and more variable forces, potentially increasing the risk of tissue trauma. Video Laryngoscope: Requires lower forces overall but involves a longer and more heterogeneous plateau phase, reflecting more adjustments for alignment.
- Safety Implications: Lower forces with video laryngoscopy may reduce tissue ischemia and trauma, but operator familiarity impacts performance.
- Training Challenges: Variability in applied forces highlights the need for targeted training, especially with less familiar devices like video laryngoscopes.
- Sensor Technology: The use of sensorized laryngoscopes provided detailed force measurement, offering a valuable tool for simulation-based education and skill enhancement.
- Limitations of Manikin Studies: While force patterns on manikins mimic human tissue responses, anatomical variability in neonates may influence real-world applicability.
- Experience and Outcomes: Operators with more intubation experience demonstrated more efficient force application and shorter intubation times.
- Insights for Trainers: Understanding force dynamics during intubation can inform teaching methods and highlight areas for skill improvement in neonatal resuscitation.
- Future Directions: Further studies on live neonates and diverse settings are needed to validate findings and optimize neonatal intubation protocols.
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