POCUS Assessment
Clinical teams, POCUS users, and research assistants were available to provide 24-hour coverage in the unit. The clinical team included an attending neonatologist, a neonatal fellow, a pediatric resident, and a staff nurse. This team assessed each newborn per standard neonatal resuscitation guidelines and determined if intubation would be required. If a neonate required intubation, it was performed by the resident or fellow as per NICU clinical guidelines and the placement of the ETT was determined using standard-of-care methods (auscultation, colorimetric capnography and CXR).
In addition to the clinical team, a POCUS user and a study research assistant were available during the intubation process. The research assistant operated independently of both the POCUS user and the clinical team. The POCUS user, following intubation, completed a POCUS examination to determine ETT placement and announced “complete” only for timing purposes. This assessment (POCUS study) was also recorded as a video. The POCUS assessment was not available to the clinical team to ensure blinding. The routine assessment of identifying placement of the endotracheal tube was carried out as per protocol without any interruption (auscultation, capnography, chest X-ray).
The POCUS user was given a maximum of 30 seconds to complete the POCUS examination, after which time the assistant notified them that their time was complete and the assessment stopped. The research assistant, who stayed in the room for the duration of the intubation, recorded the time it took for ETT confirmation from both the POCUS user and by the clinical team. If more than one intubation attempts were required for a patient, POCUS was only performed on the first attempt.