Videolaryngoscopy for Intubation in Neonates: an Evaluation– a randomized controlled study (The Vine study)

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This study is looking at methods used to intubate (insert a breathing tube that connects to a ventilator) sick infants. The standard method, which has been used internationally for many years, involves the doctor first inserting a laryngoscope into the infant’s mouth. This is an L-shaped device with a light at the tip. When it is manipulated correctly, it moves the infant’s tongue and jaw allowing a view of the infant’s airway. The doctor can then insert the breathing tube through the voice-box into the airway. This is a difficult procedure for doctors to learn and more than one attempt is often required to insert the breathing tube correctly. A more senior supervising doctor is usually present to assist during the procedure but is limited by the fact that he/she cannot see in the infant’s mouth. The devise being examined in this study is a videolaryngoscope. This is structurally the same as a traditional laryngoscope but displays real time images on to a nearby monitor. This essentially means that the assisting doctor can now see what the intubating doctor sees and can therefore potentially offer improved guidance and assistance. This is a randomised controlled trial and any infant at the Royal Women’s Hospital, Melbourne, who requires intubation, is eligible for inclusion. If the infant is very sick and needs urgent intubation, they are excluded. All intubations in the study will be performed by neonatal registrars, who are junior doctors in training. The enrolled infants will be allocated randomly into the intervention group or the control group. In the intervention group, the registrar will attempt to intubate the infant using the videolaryngoscope and standard breathing tubes. A supervising doctor will be present and view the videolaryngoscope screen. They will offer instruction to the registrar based on the images they see. In the control group, the registrar will attempt to intubate using the videolaryngoscope and standard breathing tubes. However this time, the monitor will remain covered during the intubation attempt. The registrar will still be offered verbal guidance, as would be standard current practice. In both groups it will be recorded if the first attempt resulted in correct placement of the breathing tube. The main result of the study will be a comparison of the rate of correct tube placement between the two groups.

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