A Prospective Observational Study of Video Laryngoscopy Versus Direct Laryngoscopy for Insertion of a Thin Endotracheal Catheter for Surfactant Administration in Newborn Infants

Last updated: February 18, 2025
Sponsor: University College Dublin
Overall Status: Active - Recruiting

Phase

N/A

Condition

Lung Injury

Respiratory Failure

Treatment

Video laryngoscopy used to insert thin endotracheal catheter

Direct laryngoscopy used to insert thin endotracheal catheter

Clinical Study ID

NCT06758492
NEU-VODEtec 01
  • Ages < 28
  • All Genders

Study Summary

Many premature babies have breathing difficulty after birth and receive help with a breathing machine (nasal continuous positive airway pressure, NCPAP). Some of the babies whose breathing gets worse despite NCPAP are treated with surfactant, a medication that is given directly into their windpipe (trachea). Some of the babies who are given surfactant get it through a ventilation tube (endotracheal tube, ETT), while others get it through a thin catheter that is too small for ventilation. When doctors insert a tube or a thin catheter into the windpipe of a baby, they use an instrument called a laryngoscope, which has a light at its tip, to identify the entrance. Most often doctors look directly into the baby's mouth with a standard laryngoscope to identify the entrance to the windpipe. However, newer video laryngoscopes have a camera along with the light at their tip, which displays a picture of the entrance to the windpipe on a screen. In a study performed at one hospital, doctors inserted an ETT first time more often when they used a video laryngoscope.

The investigators are doing a study at many hospitals where doctors usually use a standard laryngoscope to insert tubes and thin catheters into a baby's trachea by looking directly into the mouth. Each hospital will switch one-by-one to using a video laryngoscope when inserting a tube. The investigators will compare the information we collect to see if more babies who have a tube inserted first time without falls in their oxygen levels or heart rate with a video laryngoscope. The investigators will also collect information on babies who have a thin catheter inserted to compare whether doctors use fewer attempts when they use a video laryngoscope.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • newborn infants of any sex who are are having a thin catheter inserted into theirtrachea for the purpose of surfactant administration

Exclusion

Exclusion Criteria:

  • no parental consent provided to share their data

Study Design

Total Participants: 600
Treatment Group(s): 2
Primary Treatment: Video laryngoscopy used to insert thin endotracheal catheter
Phase:
Study Start date:
January 13, 2025
Estimated Completion Date:
December 31, 2025

Study Description

Many newborn infants have breathing difficulty after birth, particularly when they are born prematurely. Many of these infants are supported with nasal continuous positive airway pressure (NCPAP). Some of the infants deteriorate despite treatment with NCPAP and have a thin catheter inserted into their trachea for the administration of surfactant, which is then immediately removed (often referred to as "less-invasive surfactant administration" or LISA). Insertion of a thin catheter is usually performed by doctors who are experienced at intubation (i.e. inserting endotracheal tubes, ETTs). They look directly into the the infants mouth using a standard laryngoscope to identify the opening of the airway (i.e. perform direct laryngoscopy). More recently video laryngoscopes have been developed. These devices display a magnified image of the airway on a screen that can be viewed indirectly by the doctor attempting to insert the ETT or thin catheter, and also by others. A single centre study reported that more infants were successfully intubated at the first attempt when doctors performed indirect video laryngoscopy compared to direct laryngoscopy.

It is possible to independently verify when a doctor has correctly inserted and ETT, for example by detecting carbon dioxide coming out of the tube or seeing condensation in the tube during exhalation, or by hearing breath sounds by listening to the chest during positive pressure inflations. It is not possible to independently verify whether a doctor has correctly inserted a thin catheter under direct laryngoscopy, by these or other means. The standard (and to date only) way of confirming that a thin catheter has been correctly inserted is to rely on the report of the operator. Video laryngoscopy, in contrast, allows the independent verification of the tip of a thin catheter by one or more people observing the screen.

The investigators are performing NEU-VODE, a stepped wedge cluster randomised study of the introduction of video laryngoscopy versus direct laryngoscopy for the intubation of newborn infants. Alongside this study, the investigators are performing a study of infants who have a thin endotracheal catheter inserted under video laryngoscopy versus direct laryngoscopy. As it is not possible to measure the outcome of successful insertion of the thin catheter equally in both groups, this is a prospective observational cohort study. The investigators will record information on infants who have a thin catheter inserted into the trachea for the purpose of surfactant administration at centres participating in the NEU-VODE study. The type of laryngoscope used for thin catheter insertion attempts will not be mandated; instead, the investigators will compare the information of groups within the cohort who have their first attempt made using the video laryngoscope to the group who have their first attempt made with direct laryngoscopy.

Connect with a study center

  • Clinical Hospital Centre

    Rijeka,
    Croatia

    Active - Recruiting

  • Clinical Hospital "Holy Spirit"

    Zagreb,
    Croatia

    Active - Recruiting

  • Sisters of Charity Hospital

    Zagreb,
    Croatia

    Site Not Available

  • University Hospital Brno

    Brno,
    Czech Republic

    Active - Recruiting

  • General University Hospital

    Prague,
    Czech Republic

    Active - Recruiting

  • Institute for Mother and Child Care

    Prague,
    Czech Republic

    Active - Recruiting

  • Aristotle University of Thessaloniki

    Thessaloniki,
    Greece

    Active - Recruiting

  • Second Semmelweiss University

    Budapest,
    Hungary

    Site Not Available

  • University of Padova

    Padova,
    Italy

    Site Not Available

  • Oslo University Hospital

    Oslo,
    Norway

    Active - Recruiting

  • Medical University of Gdańsk

    Gdańsk,
    Poland

    Active - Recruiting

  • Medical University of Silesia

    Katowice,
    Poland

    Active - Recruiting

  • Poznań University of Medical Sciences

    Poznań,
    Poland

    Active - Recruiting

  • Provincial Hospital No. 2

    Rzeszow,
    Poland

    Active - Recruiting

  • Clinical County Emergency Hospital

    Sibiu,
    Romania

    Active - Recruiting

  • George Emil Palade University

    Targu Mures,
    Romania

    Active - Recruiting

  • University and Polytechnic Hospital La Fe

    Valencia,
    Spain

    Active - Recruiting

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