NextGen Learning To Elevate Your Airway Practice
Video laryngoscopy (VL) benefits have been widely discussed and promoted for adult intubations. However, direct laryngoscopy with a Miller blade remains the go-to option for neonatal airways.
2024 may change that. A randomized trial published in The New England Journal of Medicine showed that video laryngoscopy had a higher first-attempt success rate of 74%. This was compared to direct laryngoscopy, which had a success rate of 45% among neonates undergoing urgent intubation. [1] This study also found that video laryngoscopy required fewer attempts to achieve successful intubation and was associated with higher oxygen saturation and heart rate during the procedure.
A systematic review and meta-analysis in the European Journal of Pediatrics confirmed these findings, showing that video laryngoscopy improved first-attempt success rates in neonates (RR 1.18, CI: 1.03-1.36) and was associated with fewer adverse events such as desaturation and nasal/oral trauma.[2]
Additionally, data from the National Emergency Airway Registry for Neonates indicated that video laryngoscopy use varied across NICUs but was associated with fewer tracheal intubation-associated events. However, it did not independently increase first-attempt success rates after adjustment.[3]
In summary, video laryngoscopy appears to benefit neonatal intubations by enhancing first-attempt success rates and reducing adverse events, making it a valuable tool in clinical practice and training settings.
Learn to Manage the Neonatal Airway
The neonatal airway highlights the crucial distinctions between pediatrics and adults, necessitating specific skills for effective management. This PAC Learning Space covers all the essentials of managing the neonatal airway to ensure you are fully prepared.
References
[1] Geraghty LE, Dunne EA, Ní Chathasaigh CM, et al. Video Versus Direct Laryngoscopy for Urgent Intubation of Newborn Infants. The New England Journal of Medicine. 2024;390(20):1885-1894. doi:10.1056/NEJMoa2402785.
[2] Kuitunen I, Räsänen K, Huttunen TT. Video Laryngoscopy in Neonate and Infant Intubation-a Systematic Review and Meta-Analysis. European Journal of Pediatrics. 2024;184(1):34. doi:10.1007/s00431-024-05839-2.
[3] Moussa A, Sawyer T, Puia-Dumitrescu M, et al. Does Videolaryngoscopy Improve Tracheal Intubation First Attempt Success in the NICUs? A Report From the NEAR4NEOS. Journal of Perinatology: Official Journal of the California Perinatal Association. 2022;42(9):1210-1215. doi:10.1038/s41372-022-01472-9.
Reviewed Using Open Evidence
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