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Kocaturk O, Keles S. Comparison of the HugeMed video laryngoscope with the Macintosh direct laryngoscope for nasotracheal tracheal intubation in children undergoing dental treatment: a randomized controlled clinical study. Expert Rev Med Devices 2024:1-8. [PMID: 38829609 DOI: 10.1080/17434440.2024.2363289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/26/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES The aim of this study was to compare the performance of the HugeMed® videolaryngoscope with a direct Macintosh laryngoscope for nasotracheal intubation. METHODS Eighty-eight children aged 4-10 years were randomly assigned to either the HugeMed® videolaryngoscope (HVL) or the Macintosh direct laryngoscope (MDL) group. Intubation difficulty, glottic view grade, time-to-intubation, number of tracheal intubation attempts, use of external laryngeal manipulation and Magill forceps, recovery time, pediatric-anesthesia-delirium-scale (PAEDS) scores, pain due to tracheal intubation, and laryngeal bleeding were evaluated. RESULTS Easy tracheal intubation incidence was higher in the HVL group than that in the MDL group (p = 0.001). Glottic view was better in the HVL group as compared to the MDL group (p = 0.027). There was no difference between the groups in terms of time-to-tracheal intubation, number of tracheal intubation attempts, Magill forceps usage, pain, and bleeding due to tracheal intubation. The need for external laryngeal manipulation (p = 0.004) and PAEDS scores (p = 0.006) were higher in the MDL group than those in the HVL group. CONCLUSION HugeMed® videolaryngoscope may provide easier tracheal intubation, create a better glottic view, and significantly reduce the need for additional manipulation compared to the Macintosh direct laryngoscope, for nasotracheal intubation. CLINICAL TRIAL REGISTRATION www.clinicaltrial.gov identifier is NCT05121597.
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Affiliation(s)
- Ozlem Kocaturk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Division of Anesthesiology, Aydin Adnan Menderes University, Aydın, Turkey
| | - Sultan Keles
- Department of Pediatric Dentistry, Faculty of Dentistry, Aydin Adnan Menderes University, Aydin, Turkey
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2
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Ming Y, Chu S, Yang K, Zhang Z, Wu Z. Network meta-analysis of comparative efficacy and safety of intubation devices in children. Sci Rep 2023; 13:18626. [PMID: 37903873 PMCID: PMC10616294 DOI: 10.1038/s41598-023-45173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
To evaluate the comparative efficacy and safety of different intubation devices on intubation outcomes in pediatric intubation. We identified relevant studies from previous meta-analyses and literature retrieval in PubMed, EMBASE, and Cochrane Library. The primary outcome was the first-pass success (FPS), and the secondary outcome included the time to intubation (TTI) and the risk of local complications (LC). Network meta-analysis was performed using STATA 14.0. Twenty-three randomized comparative trials (RCTs) including 12 devices were included. Compared with Macintosh, Airtraq (odds ratio [OR] = 13.05, 95% confidence interval [CI] = 4.68 to 36.38), Miller (OR = 4.77, 95%CI = 1.32 to 17.22), Glidescope (OR = 2.76, 95%CrI = 1.60 to 4.75) and McGrath (OR = 4.61, 95%CI = 1.18 to 17.99) obtained higher PFS. Meanwhile, Airtraq was superior to Glidescope (OR = 0.21, 95%CI = 0.07 to 0.65) for PFS. For TTI, Canada was superior to other intubation devices, as well as CMAC was superior to TruViewEVO2, Glidescope, and StorzDCI. Airtraq lowered the risk of LC compared with Macintosh and Pentax but there was no statistical difference between Airtraq and KingVision. Airtraq may be the optimal option for FPS, Canada for TTI, and KingVision for LC in pediatric intubation.
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Affiliation(s)
- Yu Ming
- College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, 430023, Hubei, China
| | - Shujuan Chu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kai Yang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Zhouyang Wu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Epp K, Zimmermann S, Wittenmeier E, Kriege M, Dette F, Schmidtmann I, Pirlich N. Video Laryngoscopy Using King Vision™ aBlade™ and Direct Laryngoscopy in Paediatric Airway Management: A Randomized Controlled Study about Device Learning by Anaesthesia Residents. J Clin Med 2022; 11:jcm11195676. [PMID: 36233540 PMCID: PMC9573319 DOI: 10.3390/jcm11195676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Airway management in children is challenging due to anatomical and physiological differences. This randomized trial investigates whether anaesthesia residents can intubate the paediatric trachea more quickly and with a higher success rate using the King Vision™ Paediatric aBlade™ video laryngoscope (KVL) compared to conventional direct laryngoscopy (DL). Methods: Eleven anaesthesia residents (mean age: 31 years, mean training status 47 months) were each asked to perform intubations with the KVL and DL in paediatric patients. The primary outcome was the first-attempt success rate. Secondary outcomes were the time to best view (TTBV), time to placement of the tracheal tube (TTP), time to ventilation (TTV), and participant-reported ease of use on a Likert scale. Results: 105 intubations with the KVL and 106 DL were performed by the residents. The success rate on the first attempt with the KVL was 81%, and the success rate on the first attempt within a given time limit of 30 s was 45%, which was lower than with DL (93% and 77% with time limit, p < 0.01). The median TTBV [IQR] on the first attempt with KVL was 7 [5−10] s, the median TTP was 28 [19−44] s, and the median TTV was 51 [39−66] s. DL-mediated intubation was significantly faster (TTP: 17 [13−23] s; p < 0.0001 and TTV: 34 [28−44] s; p < 0.001). Application of the KVL was rated as difficult or very difficult by 60% of the residents (DL: 5%). Conclusion: In contrast to promising data on the paediatric training manikin, residents took longer to intubate the airway in children with the KVL and were less successful compared to the DL. Therefore, the KVL should not be recommended for learning paediatric intubation by residents.
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Affiliation(s)
- Katharina Epp
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Sophie Zimmermann
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Eva Wittenmeier
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Frank Dette
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Nina Pirlich
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Correspondence:
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Hung KC, Chen JY, Feng IJ, Chiang MH, Wu SC, Chen IW, Lin YT, Chang YJ, Wu ZF, Lu HF, Sun CK. Efficacy and airway complications of Parker Flex-Tip tubes and standard endotracheal tubes during airway manipulation: A meta-analysis and trial sequential analysis. Eur J Anaesthesiol 2021; 38:813-824. [PMID: 34001761 DOI: 10.1097/eja.0000000000001539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite reported superior intubation outcomes associated with Parker Flex-Tip (PFT) tubes compared with those associated with standard polyvinylchloride tubes, the efficacy and safety of PFT tubes remain uncertain. OBJECTIVES To compare the intubation outcomes between PFT and conventional standard polyvinylchloride tubes. DESIGN Meta-analysis of randomised controlled trials. DATA SOURCES Embase, Medline, Google Scholar, PubMed and the Cochrane controlled trials register from inception until 3 January 2021. ELIGIBILITY CRITERIA All randomised trials comparing intubation outcomes between PFT (PFT group) and standard polyvinylchloride (standard polyvinylchloride group) tubes. RESULTS Analysis of the 13 eligible trials showed no significant difference in successful first-attempt intubation rate [risk ratio (RR) 1.20, 95% confidence interval (CI) 0.99 to 1.44] (6 trials, 568 participants), trauma risk (RR 0.83, 95% CI 0.67 to 1.03) (5 trials, 501 participants) as well as the overall risks of epistaxis (RR 0.58, 95% CI 0.26 to 1.31) (3 trials, 262 participants), sore throat (RR 0.90, 95% CI 0.70 to 1.17) (4 trials, 451 participants) and hoarseness (RR 0.71, 95% CI 0.44 to 1.14) (4 trials, 451 participants) between the two groups. However, the intubation time was slightly shorter (weighted mean difference -4.2 s, 95% CI -7.4 to -1.0 s) (8 trials, 759 participants) and the risks of severe epistaxis (RR 0.15, 95% CI 0.03 to 0.84) (3 trials, 262 participants) and overall difficulty in airway manipulation (RR 0.48, 95% CI 0.29 to 0.80) (8 trials, 647 participants) were lower in the PFT group than those in the standard polyvinylchloride group. Trial sequential analysis conclusively confirmed a shorter intubation time with PFT tubes than with standard polyvinylchloride tubes, whereas other intubation outcomes were inconclusive. CONCLUSION The use of PFT tubes for airway manipulation was associated with a shorter intubation time compared with the standard polyvinylchloride tubes. The results of trial sequential analysis suggest the need for further trials and meta-analysis to compare other intubation outcomes associated with the two devices. TRIAL REGISTRATION PROSPERO CRD42020197670.
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Affiliation(s)
- Kuo-Chuan Hung
- From the Department of Anaesthesiology, Chi Mei Medical Center (KC-H, JY-C, IW-C, YT-L, YJ-C, ZF-W), Department of Health and Nutrition (KC-H), Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan City (JY-C), Institute of Precision Medicine, National Sun Yat-sen University (IJ-F), Department of Anaesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City (MH-C, SC-W, HF-L), Center of General Education, Chia Nan University of Pharmacy and Science, Tainan City (YT-L), Department of Emergency Medicine, E-Da Hospital, Kaohsiung city (CK-S) and College of Medicine, I-Shou University, Kaohsiung City, Taiwan (CK-S)
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Gupta A, Sharma R, Gupta N. Evolution of videolaryngoscopy in pediatric population. J Anaesthesiol Clin Pharmacol 2021; 37:14-27. [PMID: 34103817 PMCID: PMC8174446 DOI: 10.4103/joacp.joacp_7_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022] Open
Abstract
Direct laryngoscopy has remained the sole method for securing airway ever since the inception of endotracheal intubation. The recent introduction of video-laryngoscopes has brought a paradigm shift in the pratice of airway management. It is claimed that they improve the glottic view and first pass success rates in adult population. The airway management in children is more challenging than adults. The role of videolaryngoscopy for routine intubation in children is not clearly proven. This review attempts to discuss various videolaryngosocpes available for use in pediatric patients.
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Affiliation(s)
- Anju Gupta
- Department of Anaesthesia, Pain Medicine and Criticial Care, All India Institute of Medical Sciences, Delhi, India
| | - Ridhima Sharma
- Department of Anesthesiology, SPHPGTI, Noida, Uttar Pradesh, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Care, DRBRAIRCH, AIIMS, Delhi, India
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6
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Efune PN, Saynhalath R, Blackwell JM, Steiner JW, Olomu PN, Szmuk P. The Truview PCD™ video laryngoscope for nasotracheal intubation in pediatric patients: A subset analysis from a prospective randomized controlled trial. Paediatr Anaesth 2020; 30:1157-1158. [PMID: 32805748 DOI: 10.1111/pan.14005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Proshad Nemati Efune
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center and Children's Health Medical Center, Dallas, TX, USA.,Outcomes Research Consortium, Cleveland, OH, USA
| | - Rita Saynhalath
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center and Children's Health Medical Center, Dallas, TX, USA.,Outcomes Research Consortium, Cleveland, OH, USA
| | - James-Michael Blackwell
- Department of Population and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey W Steiner
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center and Children's Health Medical Center, Dallas, TX, USA.,Outcomes Research Consortium, Cleveland, OH, USA
| | - Patrick N Olomu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center and Children's Health Medical Center, Dallas, TX, USA
| | - Peter Szmuk
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center and Children's Health Medical Center, Dallas, TX, USA.,Outcomes Research Consortium, Cleveland, OH, USA
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7
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Hu X, Jin Y, Li J, Xin J, Yang Z. Efficacy and safety of videolaryngoscopy versus direct laryngoscopy in paediatric intubation: A meta-analysis of 27 randomized controlled trials. J Clin Anesth 2020; 66:109968. [PMID: 32645564 DOI: 10.1016/j.jclinane.2020.109968] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Anatomical and physiological differences in paediatric and adult airways make intubation of paediatric patients a challenge. This study aimed to compare the efficacy and safety of video laryngoscopy (VL) to direct laryngoscopy (DL) on intubation outcomes in paediatric patients. DESIGN Systematic review and meta-analysis. SETTING Operating room. PATIENTS Paediatric patients who needed tracheal intubation. INTERVENTION Video laryngoscopy or direct laryngoscopy. MEASUREMENTS Electronic searches in PubMed, Embase, and the Cochrane Library were performed to identify relevant randomized controlled trials published through January 2020. Outcomes included time to intubate, intubation failure at first attempt, Cormack-Lehane laryngeal view grade, intubation difficulty scale (IDS), percentage of glottic opening score (POGO), optimal external laryngeal manipulation (OLEM), and complications. Relative risks and weighted mean difference (WMD), with 95% CI, were employed to calculate summary results using a random-effects model. MAIN RESULTS Overall, 27 trials including 2461 paediatric patients were analysed. Children with video laryngoscopy intubation required longer time to intubate than direct laryngoscopy intubation (WMD 3.41, 95% CI: 1.29-5.53, P = 0.002), whereas infants receiving video laryngoscopy and direct laryngoscopy intubation experienced similar time to intubate (WMD 1.72, 95% CI: -1.09-4.54, P = 0.230). No significant differences were observed on intubation failure at first attempt between video laryngoscopy and direct laryngoscopy intubations in children and infants, respectively. Video laryngoscopy improved the POGO and intubation trauma but not Cormack-Lehane laryngeal view grade, IDS, external laryngeal manipulation, hoarseness, or oxygen desaturation. CONCLUSIONS Compared with direct laryngoscopy intubation, there were no benefits for paediatric patients with video laryngoscopy on time to intubate and failure at first attempt, but there were benefits with regard to POGO and intubation trauma.
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Affiliation(s)
- Xiaoxue Hu
- Department of Anesthesiology, Guanghua Integrative Medicine Hospital, Shanghai university of traditional Chinese Medicine, Shanghai 200052, China
| | - Yi Jin
- Department of Anesthesiology, Guanghua Integrative Medicine Hospital, Shanghai university of traditional Chinese Medicine, Shanghai 200052, China
| | - Jiansong Li
- Department of Anesthesiology, Guanghua Integrative Medicine Hospital, Shanghai university of traditional Chinese Medicine, Shanghai 200052, China
| | - Jiechen Xin
- Department of Anesthesiology, Guanghua Integrative Medicine Hospital, Shanghai university of traditional Chinese Medicine, Shanghai 200052, China
| | - Zeyong Yang
- Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Embryo Original Disease; Shanghai Municipal Key Clinical Specialty, Shanghai 200030, China.
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8
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Chiew WLA, Tan LZ, Tan DJA, Bin WH, Joshi A, Seet E. Use of King Vision® videolaryngoscope for nasotracheal intubation: A prospective observational study. J Clin Anesth 2019; 58:3-4. [PMID: 31004975 DOI: 10.1016/j.jclinane.2019.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Wan-Ling Alyssa Chiew
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore 768828, Singapore.
| | - Leng Zoo Tan
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore 768828, Singapore
| | - Daryl Jian An Tan
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore 768828, Singapore
| | - Wern Hsien Bin
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore 768828, Singapore
| | - Ashutosh Joshi
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore 768828, Singapore
| | - Edwin Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore 768828, Singapore
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9
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A comparison of the Macintosh laryngoscope, McGrath video laryngoscope, and Pentax Airway Scope in paediatric nasotracheal intubation. Sci Rep 2018; 8:17365. [PMID: 30478457 PMCID: PMC6255773 DOI: 10.1038/s41598-018-35857-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/11/2018] [Indexed: 12/22/2022] Open
Abstract
We evaluated the performance of the McGrath video laryngoscope and Pentax Airway Scope in comparison with the Macintosh laryngoscope for nasotracheal intubation in paediatric patients. For this, 108 patients were enrolled in an open-label, randomized controlled trial. Patients were randomly allocated to one of three groups based on use of the Macintosh laryngoscope, McGrath video laryngoscope, or Pentax Airway Scope. Time to intubation, the intubation difficulty, and the quality of navigation were compared among groups. The median nasotracheal intubation time [interquartile range] in the Macintosh group (33.5 [28.3–39.8] s) was significantly shorter than those of the McGrath (39.0 [32.0–43.0] s) and Pentax groups (43.0 [35.0–52.0] s). The difficulty of nasotracheal intubation was similar among all groups. When navigating and aligning the tube from the oropharynx into the glottic inlet, the cuff inflation method was required in significantly fewer patients for the Macintosh group (11.1%) than for the McGrath (48.6%) and Pentax (51.4%) groups. Thus, compared to the McGrath video laryngoscope and Pentax Airway Scope, the Macintosh laryngoscope allowed shorter nasotracheal intubation times and better facilitated tracheal navigation, requiring less use of the cuff inflation method to navigate the tracheal tube into the glottic inlet.
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10
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Xue FS, Liu YY, Li HX, Yang GZ. Paediatric video laryngoscopy and airway management: What's the clinical evidence? Anaesth Crit Care Pain Med 2018; 37:459-466. [DOI: 10.1016/j.accpm.2017.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 12/20/2022]
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Comparison of GlideScope Video Laryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Neonates. Anesth Analg 2018; 129:482-486. [PMID: 29985811 DOI: 10.1213/ane.0000000000003637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND GlideScope video laryngoscope (GS) has been widely used to facilitate tracheal intubation in adults and pediatric patients because it can improve glottic view. Several investigations performed in pediatric patients have shown that GS provides a better view of the glottis than direct laryngoscope (DL). However, to date, there are no studies assessing the use of GS in neonates. Therefore, we conducted a prospective study to compare time to intubate (TTI) when either GS or DL was used for endotracheal intubation in neonates. METHODS Seventy neonates (American Society of Anesthesiologists physical status I and II, scheduled to undergo elective surgery under general anesthesia) were randomized to GS group (n = 35) and DL group (n = 35). The primary outcome variable of the study was TTI. As secondary outcomes, success rate of first intubation attempt of all neonates, intubation attempts, and adverse events were also evaluated. The glottic views (depicted by Cormack and Lehane [C&L] grades) obtained with GS and DL were compared. RESULTS There were no significant differences in TTIs of neonates with all C&L grades (95% CI, -7.36 to 4.44). There was also no difference in the subgroups of neonates with C&L grades I and II (n = 30 each; 95% CI, -0.51 to 5.04). However, GS significantly shortened the TTIs of neonates with C&L grades III and IV compared to DL (n = 5 each group; 95% CI, 4.94-46.67). GS improved the glottic view as compared to DL. Although the total tracheal intubation attempts in the GS group was fewer than that in the DL group (36 vs 41), there was no significant difference (P = .19). CONCLUSIONS GS use did not decrease the TTI of all neonates and neonates with C&L grades I and II as compared to DL use; however, GS significantly decreased the TTI of neonates with C&L grades III and IV. Additionally, GS use provided improved glottic views.
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Abdelgadir IS, Phillips RS, Singh D, Moncreiff MP, Lumsden JL. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev 2017; 5:CD011413. [PMID: 28539007 PMCID: PMC6481531 DOI: 10.1002/14651858.cd011413.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Direct laryngoscopy is the method currently used for tracheal intubation in children. It occasionally offers unexpectedly poor laryngeal views. Indirect laryngoscopy involves visualizing the vocal cords by means other than obtaining a direct sight, with the potential to improve outcomes. We reviewed the current available literature and performed a meta-analysis to compare direct versus indirect laryngoscopy, or videolaryngoscopy, with regards to efficacy and adverse effects. OBJECTIVES To assess the efficacy of indirect laryngoscopy, or videolaryngoscopy, versus direct laryngoscopy for intubation of children with regards to intubation time, number of attempts at intubation, and adverse haemodynamic responses to endotracheal intubation. We also assessed other adverse responses to intubation, such as trauma to oral, pharyngeal, and laryngeal structures, and we assessed vocal cord view scores. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and trial registers (www.clinicaltrials.gov and www.controlledtrials) in November 2015. We reran the search in January 2017. We added new studies of potential interest to a list of 'Studies awaiting classification' and will incorporate them into formal review findings during the review update. We performed reference checking and citation searching and contacted the authors of unpublished data to ask for more information. We applied no language restrictions. SELECTION CRITERIA We included only randomized controlled trials. Participants were children aged 28 days to 18 years. Investigators performed intubations using any type of indirect laryngoscopes, or videolaryngoscopes, versus direct laryngoscopes. DATA COLLECTION AND ANALYSIS We used Cochrane standard methodological procedures. Two review authors independently reviewed titles, extracted data, and assessed risk of bias. MAIN RESULTS We included 12 studies (803 children) in this review and meta-analysis. We identified three studies that are awaiting classification and two ongoing studies.Trial results show that a longer intubation time was required when indirect laryngoscopy, or videolaryngoscopy, was used instead of direct laryngoscopy (12 trials; n = 798; mean difference (MD) 5.49 seconds, 95% confidence interval (CI) 1.37 to 9.60; I2 = 90%; very low-quality evidence). Researchers found no significant differences between direct and indirect laryngoscopy on assessment of success of the first attempt at intubation (11 trials; n = 749; risk ratio (RR) 0.96, 95% CI 0.91 to 1.02; I2 = 67%; low-quality evidence) and observed that unsuccessful intubation (five trials; n = 263) was significantly increased in the indirect laryngoscopy, or videolaryngoscopy, group (RR 4.93, 95% CI 1.33 to 18.31; I2 = 0%; low-quality evidence). Five studies reported the effect of intubation on oxygen saturation (n = 272; very low-quality evidence). Five children had desaturation during intubation: one from the direct laryngoscopy group and four from the indirect laryngoscopy, or videolaryngoscopy, group.Two studies (n = 100) reported other haemodynamic responses to intubation (very low-quality evidence). One study reported a significant increase in heart rate five minutes after intubation in the indirect laryngoscopy group (P = 0.007); the other study found that the heart rate change in the direct laryngoscopy group was significantly less than the heart rate change in the indirect laryngoscopy, or videolaryngoscopy, group (P < 0.001). A total of five studies (n = 244; very low-quality evidence) looked at evidence of trauma resulting from intubation. Investigators reported that only two children from the direct laryngoscopy group had trauma compared with no children in the indirect laryngoscopy, or videolaryngoscopy, group.Use of indirect laryngoscopy, or videolaryngoscopy, improved the percentage of glottic opening (five trials; n = 256). Studies noted no significant difference in Cormack and Lehane score (C&L) grade 1 (three trials; n = 190; RR 1.06, 95% CI 0.93 to 1.21; I2 = 59%). AUTHORS' CONCLUSIONS Evidence suggests that indirect laryngoscopy, or videolaryngoscopy, leads to prolonged intubation time with an increased rate of intubation failure when compared with direct laryngoscopy (very low-quality evidence due to imprecision, inconsistency, and study limitations). Review authors had difficulty reaching conclusions on adverse haemodynamic responses and other adverse effects of intubation, as only a few children were reported to have these outcomes. Use of indirect laryngoscopy, or videolaryngoscopy, might lead to improved vocal cord view, but marked heterogeneity between studies made it difficult for review authors to reach conclusions on this outcome.
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Affiliation(s)
| | - Robert S Phillips
- University of YorkCentre for Reviews and DisseminationYorkUKYO10 5DD
| | - Davinder Singh
- Leeds General InfirmaryPaediatric Intensive Care Unit L47Great George StLeedsUKLS1 3EX
| | | | - Joanne L Lumsden
- Leeds Teaching Hospitals TrustPaediatric Intensive Care Unit L47PICU Office, D Floor Clarendon Wing, Leeds General InfirmaryLeedsUKLS2 9NS
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Abdelgadir IS, Phillips RS, Moncreiff MP, Lumsden JL. Video-laryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd011413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sun Y, Lu Y, Huang Y, Jiang H. Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials. Paediatr Anaesth 2014; 24:1056-65. [PMID: 24958249 DOI: 10.1111/pan.12458] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND We reviewed the updated literature and performed a meta-analysis based on randomized controlled trials in children to compare the clinical efficacy between video laryngoscopes (VLs) and direct laryngoscopes (DLs). METHODS We searched articles published in English matching the key words 'video laryngoscope (including Airtraq, GlideScope, Storz, TruView, AWS, Bullard, McGrath)' AND 'direct laryngoscope' AND 'children (including pediatric, infant, neonate)' in PubMed, Ovid, Google Scholar, and the Cochrane Library databases. Only prospective randomized controlled trials (RCTs), which compared the use of VLs and DLs in children, were included. The relative risk (RR), weighted mean difference (WMD), and their corresponding 95% confidence interval (95% CI) were calculated using the quality effects model of the metaxl 1.3 software for outcome data. RESULTS Fourteen studies were included in this meta-analysis. Although VLs improved the glottis visualization in most children either with normal airways or with potentially difficult intubations, the time to intubation (TTI) was prolonged in comparison to DLs (WMD: 4.9 s; 95% CI: 2.6-7.1). Subgroup analysis showed the GlideScope (WMD: 5.2 s; 95% CI: 2.0-8.5), TruView (WMD: 5.1 s; 95% CI: 0.7-9.5), Storz (WMD: 6.4 s; 95% CI: 4.8-8.1), and Bullard (WMD: 37.5 s; 95% CI: 21.0-54.0) rather than Airtraq (WMD: 0.6 s; 95% CI: -7.7-8.9) prolonged TTI. Although the success rate of the first attempt (RR: 0.96; 95% CI: 0.92-1.00) and associated complications (RR: 1.11; 95% CI: 0.39-3.16) were similar in both groups, VLs were associated with a higher incidence of failure (RR: 6.70; 95% CI: 1.53-29.39). CONCLUSION This meta-analysis demonstrates that although VLs improved glottis visualization in pediatric patients, this was at the expense of prolonged TTI and increased failures. However, further studies are needed to clarify the efficacy and safety of VLs in hands of nonexperts and in children with airway problems.
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Affiliation(s)
- Yu Sun
- Department of Anesthesiology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Comparison of success rates using video laryngoscopy versus direct laryngoscopy by residents during a simulated pediatric emergency. Simul Healthc 2014; 8:155-61. [PMID: 23448854 DOI: 10.1097/sih.0b013e318284598a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Emergency airway situations are relatively rare events in pediatrics with most graduating residents having little exposure to intubate. Newer video technology offers the promise of reducing complications associated with intubation. This study proposes that video laryngoscopy (VL) should aid less skilled residents to intubate an infant mannequin with greater success and speed as compared with traditional direct laryngoscopy (DL). METHODS Pediatric (PED) and emergency medicine (EM) residents were randomized in a prospective controlled study. A standard respiratory failure scenario was conducted using SimBaby with an uncomplicated airway. Residents who inadvertently performed esophageal intubation were made aware as part of the scenario and allowed to reattempt until successful. RESULTS Sixty-nine residents voluntarily participated, 49% EM and 51% PED. Seven subjects in the DL group required multiple attempts (21%), compared with 6 subjects in the VL group (17%) (P = 0.718). Median time to intubation was 30 seconds (95% confidence interval [CI], 19-41 seconds) for DL and 39 seconds (95% CI, 36-42 seconds) for VL (P = 0.111). Comparison of programs revealed a 77% PED success rate versus 85% EM success rate (P = 0.578) and median time to intubation of 38 seconds (95% CI, 31-45 seconds) for PED compared with 32 seconds (95% CI, 23-41 seconds) for EM residents (P = 0.316). In a subanalysis, subjects successful at first attempt revealed a 13-second median difference (DL, 23 seconds [95% CI, 18-28 seconds] vs. VL, 36 seconds [95% CI, 29-43 seconds; P = 0.01). CONCLUSIONS In a simulated respiratory failure scenario involving residents, VL provided no additional success over DL with slightly longer time to intubation.
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[Glottiscopes and videolaryngoscopes: a rational choice?]. ACTA ACUST UNITED AC 2013; 32:e211-5. [PMID: 24246658 DOI: 10.1016/j.annfar.2013.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Different airway devices can be used by paediatrician anaesthesiologists for difficult airway management in infant younger than 2 years. The four devices analyzed (Airtraq® [Prodol Meditec]; Glidescope® Cobalt [Verathon]; Vidéolaryngoscope [Storz]; laryngoscope Truview® [Truphatek]) increase the Cormack and Lehane grade against direct laryngoscopy and optimized external larynx movements. They need training, on manikin then in vivo, for an optimal use. The needed number of in vivo successful intubations is not determined. It is probably between 10 and 20. The choice between these devices, in accordance with the published studies, which compared the devices, is difficult. The manikin studies allow to standardize airway, but the results are not transposable in vivo. Concerning the airway devices with disposable blade, the Glidescope®, for oral intubation, seems to be better than Airtraq® if we take into account the oropharyngeal volume needed.
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Abstract
The history of pediatric anesthesia is fascinating in terms of how inventive anesthesiologists became over time to address the needs for advances in surgery. We have many pioneers and heroes. We hope you will enjoy this brief overview and that we have not left out any of the early contributors to our speciality. Obviously there is insufficient space to include everyone.
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Affiliation(s)
- Christine L Mai
- Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, The MassGeneral Hospital for Children, Massachusetts General Hospital, Boston, MA 02114, USA.
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Xue FS, Liu HP, Liao X, Yuan YJ, Liu JH. Performance of GlideScope(®) videolaryngoscope for nasotracheal intubation in children. Paediatr Anaesth 2011; 21:1075-6. [PMID: 21981095 DOI: 10.1111/j.1460-9592.2011.03623.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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