Abstract：
OBJECTIVE: To identify associations between procedural characteristics and success of neonatal tracheal intubation (NTI) using video laryngoscopy (VL).
METHODS: Prospective single-centre observational study.
METHODS: Quaternary neonatal intensive care unit.
METHODS: Infants requiring NTI at the Children\'s Hospital of Philadelphia.
METHODS: VL NTI recordings were evaluated to assess 11 observable procedural characteristics hypothesised to be associated with VL NTI success. These characteristics included measures of procedural time and performance, glottic exposure and position, and laryngoscope blade tip location.
METHODS: VL NTI attempt success.
RESULTS: A total of 109 patients underwent 109 intubation encounters with 164 intubation attempts. The first attempt success rate was 65%, and the overall encounter success rate was 100%. Successful VL NTI attempts were associated with shorter procedural duration (36 s vs 60 s, p<0.001) and improved Cormack-Lehane grade (63% grade I vs 49% grade II, p<0.001) compared with unsuccessful NTIs. Other factors more common in successful NTI attempts than unsuccessful attempts were laryngoscope blade placement to lift the epiglottis (45% vs 29%, p=0.002), fewer tracheal tube manoeuvres (3 vs 8, p<0.001) and a left-sided or non-visualised tongue location (76% vs 56%, p=0.009).
CONCLUSIONS: We identified procedural characteristics visible on the VL screen that are associated with NTI procedural success. Study results may improve how VL is used to teach and perform neonatal intubation.
METHODS: Prospective single-centre observational study.
METHODS: Quaternary neonatal intensive care unit.
METHODS: Infants requiring NTI at the Children\'s Hospital of Philadelphia.
METHODS: VL NTI recordings were evaluated to assess 11 observable procedural characteristics hypothesised to be associated with VL NTI success. These characteristics included measures of procedural time and performance, glottic exposure and position, and laryngoscope blade tip location.
METHODS: VL NTI attempt success.
RESULTS: A total of 109 patients underwent 109 intubation encounters with 164 intubation attempts. The first attempt success rate was 65%, and the overall encounter success rate was 100%. Successful VL NTI attempts were associated with shorter procedural duration (36 s vs 60 s, p<0.001) and improved Cormack-Lehane grade (63% grade I vs 49% grade II, p<0.001) compared with unsuccessful NTIs. Other factors more common in successful NTI attempts than unsuccessful attempts were laryngoscope blade placement to lift the epiglottis (45% vs 29%, p=0.002), fewer tracheal tube manoeuvres (3 vs 8, p<0.001) and a left-sided or non-visualised tongue location (76% vs 56%, p=0.009).
CONCLUSIONS: We identified procedural characteristics visible on the VL screen that are associated with NTI procedural success. Study results may improve how VL is used to teach and perform neonatal intubation.
摘要：
目的：确定手术特征与使用视频喉镜（VL）的新生儿气管插管（NTI）成功之间的关联。
方法：前瞻性单中心观察性研究。
方法：第四纪新生儿重症监护病房。
方法：在费城儿童医院需要NTI的婴儿。
方法：对VLNTI记录进行评估，以评估假设与VLNTI成功相关的11个可观察到的手术特征。这些特征包括程序时间和性能的衡量标准，声门暴露和位置，和喉镜叶尖的位置。
方法：VLNTI尝试成功。
结果：共有109例患者经历了109次插管，164次插管尝试。首次尝试成功率为65%,整体相遇成功率为100%。成功的VLNTI尝试与较短的手术持续时间相关(36秒vs60秒，p<0.001），并提高了Cormack-Lehane等级（I级为63％，II级为49％，p<0.001）与不成功的NTI相比。在成功的NTI尝试中，比失败的尝试更常见的其他因素是喉镜刀片放置以抬起会厌（45％vs29％，p=0.002),更少的气管导管操作（3vs8，p<0.001）和左侧或非可视化的舌头位置（76％vs56％，p=0.009)。
结论：我们确定了VL屏幕上可见的与NTI手术成功相关的手术特征。研究结果可能会改善VL如何用于教导和执行新生儿插管。
方法：前瞻性单中心观察性研究。
方法：第四纪新生儿重症监护病房。
方法：在费城儿童医院需要NTI的婴儿。
方法：对VLNTI记录进行评估，以评估假设与VLNTI成功相关的11个可观察到的手术特征。这些特征包括程序时间和性能的衡量标准，声门暴露和位置，和喉镜叶尖的位置。
方法：VLNTI尝试成功。
结果：共有109例患者经历了109次插管，164次插管尝试。首次尝试成功率为65%,整体相遇成功率为100%。成功的VLNTI尝试与较短的手术持续时间相关(36秒vs60秒，p<0.001），并提高了Cormack-Lehane等级（I级为63％，II级为49％，p<0.001）与不成功的NTI相比。在成功的NTI尝试中，比失败的尝试更常见的其他因素是喉镜刀片放置以抬起会厌（45％vs29％，p=0.002),更少的气管导管操作（3vs8，p<0.001）和左侧或非可视化的舌头位置（76％vs56％，p=0.009)。
结论：我们确定了VL屏幕上可见的与NTI手术成功相关的手术特征。研究结果可能会改善VL如何用于教导和执行新生儿插管。
