A prospective observational study of video laryngoscopy‐guided coaching in the pediatric intensive care unit
Bibliographic record
Abstract
Abstract Background There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room. Aim Our primary aim was to evaluate whether implementation of video laryngoscopy‐guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation‐associated events. Methods This is a pre‐post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single‐center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation‐associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured. Results Among 580 tracheal intubations, 284 (49%) were performed during the preimplementation phase, and 296 (51%) postimplementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% postimplementation) and sustained. There were no statistically significant differences in adverse tracheal intubation‐associated events between the two phases (pre‐ 9% vs. post‐ 5%, absolute difference −3%, CI 95 : −8% to 1%, p = .11), oxygen desaturations <80% (pre‐ 13% vs. post‐ 13%, absolute difference 1%, CI 95 : –6% to 5%, p = .75), or first attempt success (pre‐ 73% vs. post‐ 76%, absolute difference 4%, CI 95 : –3% to 11%, p = .29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI 95 : 23% to 51%, p < .001). Conclusions Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation‐associated events and oxygen desaturation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".