Study objective

Our study objectives were to describe patterns of video laryngoscope screen visualization during tracheal intubation in a pediatric emergency department (ED) and to determine their associations with procedural performance.

Methods

We conducted a prospective, observational, video-based study of pediatric ED patients undergoing tracheal intubation with a standard geometry video laryngoscope (Storz C-MAC; Karl Storz, Tuttlingen, Germany). Our primary exposure was video screen visualization patterns, measured by the percentage of each attempt spent viewing the screen and the number of times the proceduralist changed their gaze between the patient and screen (gaze switches). Our primary outcome was first-pass success. We compared measures of screen visualization between successful and unsuccessful first attempts using a generalized linear mixed model.

Results

From December 2019 to October 2021, we collected data on 153 patients. The first-pass success rate was 79.1%. Proceduralists viewed the video screen during 80.4% of attempts; the median percentage of each attempt spent viewing the video screen was 42.1% (interquartile range 8.7% to 65.5%). The median number of gaze switches per attempt was 3 (interquartile range 1 to 6, maximum 22). The percentage of each attempt spent viewing the video screen was not associated with success (adjusted odds ratio 1.00, 95% confidence interval 0.93 to 1.08); additional gaze switches were associated with a lower likelihood of success (adjusted odds ratio 0.80, 95% confidence interval 0.71 to 0.90).

Conclusion

We found wide variation in how proceduralists viewed the video laryngoscope screen during intubations in a pediatric ED. We illustrate the application of 2 objective screen visualization measures to quantify and understand how clinicians actually use video laryngoscopy.

中文翻译：

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视频喉镜屏幕可视化和气管插管性能：儿科急诊科的基于视频的研究

学习目标

我们的研究目标是描述儿科急诊科 (ED) 气管插管过程中视频喉镜屏幕可视化的模式，并确定它们与操作性能的关系。

方法

我们对使用标准几何视频喉镜（Storz C-MAC；Karl Storz，德国图特林根）进行气管插管的儿科 ED 患者进行了一项前瞻性、观察性、基于视频的研究。我们的主要暴露是视频屏幕可视化模式，通过每次尝试观看屏幕的百分比和程序化专家在患者和屏幕之间改变视线的次数（视线切换）来衡量。我们的主要成果是一次成功。我们使用广义线性混合模型比较了成功和不成功的首次尝试之间的屏幕可视化测量。

结果

从 2019 年 12 月到 2021 年 10 月，我们收集了 153 名患者的数据。首过成功率为79.1%。程序专家在 80.4% 的尝试中查看了视频屏幕；每次尝试观看视频屏幕的中位数百分比为 42.1%（四分位距为 8.7% 至 65.5%）。每次尝试凝视切换的中位数为 3 次（四分位距为 1 至 6，最多 22 次）。每次观看视频屏幕的尝试百分比与成功无关（调整优势比 1.00，95% 置信区间 0.93 至 1.08）；额外的注视转换与较低的成功可能性相关（调整优势比 0.80，95% 置信区间 0.71 至 0.90）。

结论

我们发现，在儿科 ED 插管期间，操作人员如何查看视频喉镜屏幕存在很大差异。我们说明了 2 个客观屏幕可视化措施的应用，以量化和了解临床医生如何实际使用视频喉镜。