Endotracheal intubation is a common part of management of the airway and respiratory status of infants and children in the neonatal and pediatric intensive care units and in the operating room. Complications of improper endotracheal intubation range from mild airway edema to the growth of incapacitating inflammatory tissue to the development of subglottic or tracheal stenosis. In addition, incidental or unplanned extubations have potential to propagate significant short term and long term complications. Some complications of endotracheal intubation may be prevented by improving the understanding and comfort level of all team members involved in the care of endotracheally intubated children.
Pediatric otolaryngologists provide long-term surgical management of patients with such complications, which frequently require numerous surgical procedures and hospitalizations for voice and airway compromise and disability; non-otolaryngology neonatal and pediatric care providers within our institution have verbalized concerns for a significant deficiency in the understanding concepts in medical decision making across specialties, from emergency to operating room to long-term intensive care, in the selection and management of endotracheal intubation. We sought to assess the efficacy of implementing a pediatric otolaryngologist-driven multi-modality educational plan directed at providing the same educational module to all academic levels providing healthcare in a teaching institution’s intensive care unit.
This ongoing prospective study has enrolled 117 participants to date, including pediatric intensivists, fellows, and residents, pediatric and neonatal intensive care unit nurses, respiratory therapists, and air care and EMS personnel. The program consists of a 10-question Pre-Test; a 30-minute online PowerPoint training module reviewed for accuracy and content utility by specialists in neonatology, pediatric critical care, pediatric anesthesiology, and pediatric otolaryngology; a 90-min simulation lab led by one instructor in pediatric otolaryngology; and a 10-question post-test. The program was piloted with otolaryngology residents for clarity and utility content of materials. Data collected includes results of 10-question Pre/Post-Tests taken before and after viewing a 30 minute PowerPoint training module and attending a 90-minute interactive hands-on simulation laboratory session.
70 participants completed the entire program. The pre-test score mean was 69.3% with a SD of 25.7. The post-test score mean was 97.1% with a SD of 5.2. The two-tailed paired t-test P value is less than 0.0001.
The results of pre-testing validated the institutional concerns for a knowledge gap regarding critical concepts in medical decision making regarding the use of endotracheal tubes in patients under 18 years of age. Establishment of a multi-disciplinary and multi-faceted educational program for all care providers within the pediatric and neonatal intensive care units improved concept awareness. Open feedback suggested the combination of different media and healthcare professionals promoted teamwork. These improvements through education support the goals of reducing long-term complications of neonatal and pediatric intubation.