Video Laryngoscopy in the NICU: Lessons Learned From Implementation of a New Technology

Abstract

Background:

Endotracheal intubation is an invasive procedure commonly performed in the NICU. Direct laryngoscopy (DL) is the standard technique, while video laryngoscopy (VL) is a newer tool developed in the last 15 years. VL has been shown to increase the success rate of first-attempt intubations and potentially decrease complications such as trauma to the airway, hypoxemia, and esophageal intubation. VL technology was introduced to this NICU in May 2022.

Methods:

A survey was administered to the respiratory therapy staff in March 2023, ten months after VL implementation. The survey collected both qualitative and quantitative data using open-ended questioning and the Likert scale. All full-time, part-time, and per diem staff who had used the VL were eligible to participate. The survey response rate was 66%.

Results:

RT staff were asked to recall their most recent intubation assists in the NICU and whether the intubating physician or nurse practitioner used VL or DL. Those who used DL most recently stated that VL was not used due to physician/NP preference or lack of immediate availability of VL equipment in the unit. RTs reported similar comfort levels in assisting with VL intubations compared to DL; however, RTs had a low level of confidence in providers' ability to successfully intubate with VL.

Conclusions:

Two barriers to VL use were identified: training/education, and physical availability. RTs reported that more education is needed for providers. All RTs responded they would attend additional training sessions for the VL. The RT department had varying practices when preparing for an intubation; some RTs would bring the VL, while others would wait for the intubating provider to request the VL. In an open-ended survey question, multiple RTs described the location of the VL, stored in the RT office, as an impediment to its usage. Limitations: The NICU is within a teaching hospital, therefore trainees are able to practice their intubation skills regularly. RT confidence in provider ability may vary depending on the experience of the provider and is not necessarily VL- or DL-dependent. Recommendations: Two educator roles have been established in the RT department to assist with training and implementation of new technologies and best practices. Additionally, there is a plan to relocate VL equipment to the in-unit airway carts to improve accessibility. Further study is needed to determine if VL has decreased intubation attempts and the associated negative sequelae in this department.