Incorporating stressors during simulated neonatal endotracheal intubation creates a stress response but does not affect performance: a randomised pilot study.
Michael-Andrew Assaad, Thomas Pennaforte, Christian Lachance, Ilian Cruz Panesso, Ahmed Moussa
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引用次数: 0
Abstract
Objective: Investigate the impact of high stress (HS) using four stressors (physiological, psychological/social, contextual and situational) versus low stress (LS) on stress response and performance during simulated neonatal endotracheal intubation (ETI).
Design: Non-blinded crossover simulated randomised controlled trial. Subjects included paediatric and neonatology residents. Participants were exposed to HS and LS neonatal ETI scenarios. Primary outcomes were stress response measures: (1) physiologic: heart rate (HR) and HR variability (HRV), (2) psychologic: State-Trait Anxiety Questionnaire (STAI) responses and (3) endocrine: salivary cortisol. These were measured at baseline and pre/during/post each scenario. Secondary outcomes were intubation success rate, duration, and performance on a neonatal intubation checklist.
Results: 48 participants completed two scenarios. The HS scenario had a higher HR during (104±15 vs 100±15, mean difference 5 (1-9), p=0.03) and post (97±18 vs 93±15, mean difference 4 (0-9), p=0.04) compared with LS scenario. HRV was not different between groups. STAI trait scores did not differ, but STAI state scores were higher in the HS-post state compared with the LS-post state (38±8 vs 34±7, mean difference 4 (2-6), p=0.001). There was no significant difference in salivary cortisol between scenarios. Success rate, duration and checklist scores did not differ between scenarios.
Conclusions: It is possible to generate a modest physiologic and psychologic stress response in simulated neonatal ETI using a combination of stressors, although without raising salivary cortisol or affecting performance.
目的:探讨采用生理、心理/社会、情境和情境四种应激源的高应激(HS)与低应激(LS)对模拟新生儿气管插管(ETI)应激反应和表现的影响。设计:非盲交叉模拟随机对照试验。研究对象包括儿科和新生儿住院医师。参与者暴露于HS和LS新生儿ETI情景。主要结果是应激反应测量:(1)生理:心率(HR)和心率变异性(HRV),(2)心理:状态-特质焦虑问卷(STAI)反应,(3)内分泌:唾液皮质醇。这些是在基线和每个场景前/期间/之后测量的。次要结果是插管成功率、持续时间和新生儿插管检查表上的表现。结果:48名参与者完成了两个场景。HS方案在(104±15 vs 100±15,平均差值5 (1-9),p=0.03)和术后(97±18 vs 93±15,平均差值4 (0-9),p=0.04)较LS方案高。HRV组间无差异。两组的STAI性状得分无显著差异,但HS-post状态的STAI状态得分高于LS-post状态(38±8 vs 34±7,平均差值4 (2-6),p=0.001)。两组患者唾液皮质醇水平无显著差异。成功率、持续时间和检查表得分在不同的情况下没有差异。结论:在模拟的新生儿ETI中,使用压力源组合可以产生适度的生理和心理应激反应,尽管不会提高唾液皮质醇或影响表现。
期刊介绍:
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.