Teaching fiberoptic-assisted tracheoscopy in very low birth weight infants: A randomized controlled simulator study

OBJECTIVE: We developed a fiberoptic-assisted tracheoscopy (FAST) method to avoid direct laryngoscopy during surfactant replacement therapy and compared two training approaches on a very low birth weight (VLBW) infant simulator. DESIGN: This prospective randomized controlled study was conducted at the Department of Neonatology and Pediatric Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf, Germany. PARTICIPANTS: We recruited physicians, trainees, students, and nurses without prior experience in endoscopic techniques. INTERVENTIONS: Participants were assigned randomly to a group that received instructions according to Peyton’s Four-Step Approach and a control group that received standard bedside teaching only. MAIN OUTCOME MEASURES: Primary endpoints were the total and the component times required to place the bronchoscope and the method success. RESULTS: We recruited 186 participants. Compared with the control group, the Peyton group had a lower mean (±standard deviation) FAST completion time (33.2 ± 27.5 s vs. 79.5 ± 47.9 s, p < 0.001; d = 1.12) and a higher FAST success rate (95% vs. 84%, p = 0.036, V = 0.18). CONCLUSION: After standardized training, the vast majority of novices completed FAST successfully. Peyton’s four-step approach resulted in faster and more successful performance than standardized training.