Objective: This is a study to determine the efficacy and feasibility of videolaryngoscopy as a training tool for emergent endotracheal intubations by surgical residents in the surgical intensive care unit (SICU).
Methods: Over a fifteen month period ending December 2007, SICU patients underwent emergent endotracheal intubation using videolaryngoscopy. All residents underwent a thirty minute tutorial on a mannequin for setting up and intubating with the videolaryngoscope. All airway intubations were first attempted with the videolaryngoscope. Direct laryngoscopy was performed by senior level physicians for those who failed airway intubation with videolaryngoscope.
Results: Forty Six patients underwent attempted video intubation. Forty video intubations were successful (CI 74% to 95%). Patients with unsuccessful video intubations had subsequent successful intubation with direct laryngoscopy. Of the 40 video intubations, 15 were performed by PGY-1, sixteen by PGY-2, and nine by fellows. Furthermore, 30 of the 40 successful attempts were achieved during the first pass of the larynx (CI 59% to 87%). Of the six unsuccessful attempts, three occurred early in the study and were attributable to condensation of the lens and subsequent inability to visualize the vocal cords. This problem was rectified later in the study by suctioning the air in the oropharynx when condensation was evident on the videolaryngoscope lens. One occurred due to inability to pass the ET tube secondary to cord edema. Successful intubation was performed in this case through direct laryngoscopy and downsizing of the endotracheal tube. One failure was due to massive aspiration during intubation and one failed attempt was due to a mechanical problem with the video laryngoscope light source.
Conclusion: Our study indicates that videolayngoscopy is an effective and feasible method for training surgical residents in the SICU. Furthermore, it allows oversight and direct supervision of junior residents in the SICU during emergent intubations by monitoring on the screen. Studies with prospective randomization could determine the utility of this technique.
Program Number: P153