A. S. Thompson

1280: VIDEOLARYNGOSCOPY IMPLEMENTATION AS A COACHING DEVICE IN AN ACADEMIC PICU

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Direct laryngoscopy (DL) is an essential skill for pediatric ICU providers. Recent data suggest that adverse tracheal intubation associated events (TIAEs) are more common when trainees perform DL. One type of video laryngoscope (VL) allows laryngoscopists to perform DL while a coach can provide guidance with indirect (video) view. We hypothesize that implementation of VL coaching as a quality improvement (QI) intervention: sustains DL practice, increases first attempt success, decreases adverse TIAEs, and decreases multiple attempts (> 2). Given that VL is associated with longer procedural time, we set desaturation (SpO2 < 80%) as a counter measure. Methods: A single center pre-post study. VL coaching utilizing C-MAC (Karl Storz Inc, Germany) was implemented in a single large non-cardiac ICU as a part of tracheal intubation (TI) QI in December 2016 after in-service to all providers. Local NEAR4KIDS QI data were queried for all TIs during pre-VL (Jan-Jun 2016) and post-VL (Jan-Jun 2017) phases. Patient, provider, practice characteristics were evaluated for possible confounders. Logistic regression was used to account for confounders. Results: 345 primary TIs (169 in pre, 176 in post) were reported. There was no difference in patient age, TI indication, provider type, and paralytic use between the two periods. In post-VL period, C-MAC was used in 113 (64%) of TIs. Among these TIs, VL was used solely for coaching in 83/113 (73%) with laryngoscopists performing DL. In post-VL period, first attempt success rate was not significantly better (78% vs. pre 70%, p = 0.11). This was unchanged after controlling for provider type and medication (OR 1.46: 95% CI 0.89–2.39, p = 0.13). Adverse TIAE rate was lower (5% vs. pre 11%), but did not reach statistical significance (p = 0.06). Multiple attempt rate was similar (5% vs. pre 8%, p = 0.24). Desaturation (SpO2< 80%) rate was not different (15% vs. pre 18%, p = 0.45). Conclusions: Implementation of VL-coaching practice utilizing C-MAC sustained provider DL practice. In this preliminary analysis, VL-coaching practice did not improve first attempt success, adverse TIAE rates, multiple attempts, and the desaturation rate was unchanged.

Association of rapid head growth in children following tracheostomy tube placement.

INTRODUCTION Our clinical observation indicates that some children who have a tracheostomy may experience increasing head circumference as they grow and develop. Accurate assessment and interpretation of growth parameters is an essential component of following child development. Appreciation for variations in growth is especially important in special populations, such as children with a tracheostomy. The aim of this study is to define head growth in children with a tracheostomy. METHOD This retrospective cohort study includes children who underwent tracheostomy tube placement prior to 2 years of age in a respiratory rehabilitation unit within a childrens hospital. Serial head circumference measurements were plotted against age on growth charts adjusted for gestational age. The percentage of patients with accelerated head growth, defined as increased head circumference across two major percentiles within 6 months following tracheostomy, was determined. RESULTS Fifty-seven percent (20 out of 35 children) demonstrated increased head circumference across two major percentiles within 6 months following tracheostomy. DISCUSSION Accelerated head growth is associated with the presence of a tracheostomy tube in children in this study. Further investigation is warranted to establish the relationship of head circumference to other growth parameters. In addition, the etiology of this phenomenon requires additional study. Understanding head growth in children with a tracheostomy will promote adequate growth assessment and may lead to improved patient care.