Browsing by Subject "intubation"
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Item Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position(Springer, 2016) Turner, Joseph S.; Ellender, Timothy J.; Okonkwo, Enola R.; Stepsis, Tyler M.; Stevens, Andrew C.; Eddy, Christopher S.; Sembroski, Erik G.; Perkins, Anthony J.; Cooper, Dylan D.; Department of Emergency Medicine, IU School of MedicineThere are a number of potential physical advantages to performing orotracheal intubation in an upright position. The objective of this study was to measure the success of intubation of a simulated patient in an upright versus supine position by novice intubators after brief training. This was a cross-over design study in which learners (medical students, physician assistant students, and paramedic students) intubated mannequins in both a supine (head of the bed at 0°) and upright (head of bed elevated at 45°) position. The primary outcome of interest was successful intubation of the trachea. Secondary outcomes included log time to intubation, Cormack–Lehane view obtained, Percent of Glottic Opening score, provider assessment of difficulty, and overall provider satisfaction with the position. There were a total of 126 participants: 34 medical students, 84 physician assistant students, and 8 paramedic students. Successful tracheal intubation was achieved in 114 supine attempts (90.5 %) and 123 upright attempts (97.6 %; P = 0.283). Upright positioning was associated with significantly faster log time to intubation, higher likelihood of achieving Grade I Cormack–Lehane view, higher Percent of Glottic Opening score, lower perceived difficulty, and higher provider satisfaction. A subset of 74 participants had no previous intubation training or experience. For these providers, there was a non-significant trend toward improved intubation success with upright positioning vs supine positioning (98.6 % vs. 87.8 %, P = 0.283). For all secondary outcomes in this group, upright positioning significantly outperformed supine positioning.Item Effect of an Aerosol Box on Intubation in Simulated Emergency Department Airways: A Randomized Crossover Study(University of California, 2020-11) Turner, Joseph S.; Falvo, Lauren E.; Ahmed, Rami A.; Ellender, Timothy J.; Corson-Knowles, Dan; Bona, Anna M.; Sarmiento, Elisa J.; Cooper, Dylan D.; Emergency Medicine, School of MedicineIntroduction: The use of transparent plastic aerosol boxes as protective barriers during endotracheal intubation has been advocated during the severe acute respiratory syndrome coronavirus 2 pandemic. There is evidence of worldwide distribution of such devices, but some experts have warned of possible negative impacts of their use. The objective of this study was to measure the effect of an aerosol box on intubation performance across a variety of simulated difficult airway scenarios in the emergency department. Methods: This was a randomized, crossover design study. Participants were randomized to intubate one of five airway scenarios with and without an aerosol box in place, with randomization of intubation sequence. The primary outcome was time to intubation. Secondary outcomes included number of intubation attempts, Cormack-Lehane view, percent of glottic opening, and resident physician perception of intubation difficulty. Results: Forty-eight residents performed 96 intubations. Time to intubation was significantly longer with box use than without (mean 17 seconds [range 6-68 seconds] vs mean 10 seconds [range 5-40 seconds], p <0.001). Participants perceived intubation as being significantly more difficult with the aerosol box. There were no significant differences in the number of attempts or quality of view obtained. Conclusion: Use of an aerosol box during difficult endotracheal intubation increases the time to intubation and perceived difficulty across a range of simulated ED patients.Item Feasibility of upright patient positioning and intubation success rates at two academic emergency departments(Elsevier, 2017-07) Turner, Joseph S.; Ellender, Timothy J.; Okonkwo, Enola R.; Stepsis, Tyler M.; Stevens, Andrew C.; Sembroski, Erik G.; Eddy, Christopher S.; Perkins, Anthony J.; Cooper, Dylan D.; Emergency Medicine, School of MedicineObjectives Endotracheal intubation is most commonly taught and performed in the supine position. Recent literature suggests that elevating the patient's head to a more upright position may decrease peri-intubation complications. However, there is little data on the feasibility of upright intubation in the emergency department. The goal of this study was to measure the success rate of emergency medicine residents performing intubation in supine and non-supine, including upright positions. Methods This was a prospective observational study. Residents performing intubation recorded the angle of the head of the bed. The number of attempts required for successful intubation was recorded by faculty and espiratory therapists. The primary outcome of first past success was calculated with respect to three groups: 0–10° (supine), 11–44° (inclined), and ≥ 45° (upright); first past success was also analyzed in 5 degree angle increments. Results A total of 231 intubations performed by 58 residents were analyzed. First pass success was 65.8% for the supine group, 77.9% for the inclined group, and 85.6% for the upright group (p = 0.024). For every 5 degree increase in angle, there was increased likelihood of first pass success (AOR = 1.11; 95% CI = 1.01–1.22, p = 0.043). Conclusions In our study emergency medicine residents had a high rate of success intubating in the upright position. While this does not demonstrate causation, it correlates with recent literature challenging the traditional supine approach to intubation and indicates that further investigation into optimal positioning during emergency department intubations is warranted.Item Innovative Skills Development in Medical Students Through Neonatal Intubation Solutions(2025-04-25) Russell III, Carl; Patel, Neal; Wilson, Damen; Johnson, Ben; Sivaprakasam, Andrew; Earl, Conner; Conlon, StevenIntroduction/Background: Modern medical education is widely acknowledged for its rigor and fast pace. With a vast amount of information to absorb and apply, the focus often leans heavily on memorization and clinical proficiency. However, one aspect that is often underemphasized is the discovery of unmet needs and the development of innovative solutions to address these gaps. The Advancing Innovation in Medicine Student Interest Group (AIM SIG) serves as a platform for students to actively engage in identifying and addressing these needs. Study Objective/Hypothesis: The AIM SIG aims to foster innovative, collaborative solutions to systemic healthcare challenges. This year’s focus was the improvement of neonatal intubation techniques through novel equipment. Methods: In collaboration with Dr. Steven Conlon, a neonatologist at Riley Hospital for Children, AIM SIG members participated in a structured, stepwise process to explore and address gaps in neonatal intubation procedures. This process included both experiential learning and hands-on education in the engineering design process, offering medical students exposure to device development. Results: AIM SIG members conducted an extensive review of existing literature, intellectual property, and procedural data, culminating in a comprehensive needs assessment. Furthermore, members learned essential skills in “pretotyping” and 3D modeling, equipping them to generate proof-of-concept solutions aimed at improving neonatal intubation procedures. Conclusions: AIM SIG provides medical students with valuable opportunities to acquire skills in problem-solving and innovation. While translating these innovations into practice presents challenges and setbacks, the experience equips students with a versatile framework to address future problems they may encounter in their medical careers.Item Unanticipated Difficult Intubation In An Adult Patient(StatPearls Publishing, 2022) Traylor, Beth Ann; McCutchan, Amy; Anesthesia, School of Medicine