Incorporating stressors during simulated neonatal endotracheal intubation creates a stress response but does not affect performance: a randomised pilot study.

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.