Comparison of success of tracheal intubation using Macintosh laryngoscope-assisted Bonfils fiberscope and Truview video laryngoscope in simulated difficult airway

Safety and effectiveness of endotracheal intubation in critically ill emergency patients with videolaryngoscopy

To investigate the safety and efficacy of video laryngoscopy for endotracheal intubation in critically ill patients. A total of 106 critically ill emergency patients treated at our hospital between January 2021 and June 2022 were randomly divided into 2 groups, the visual and direct groups, with 53 patients in each group. Both groups were treated with endotracheal intubation; the visual group was treated with video laryngoscopy, and the direct group was treated with conventional direct laryngoscopy. The Cormack-Lehane grade, percentage of glottic opening score, success rate of one intubation, intubation time, number of intubation attempts, hemodynamic values, and complications were compared between the 2 groups. The success rates of glottis exposure and one-time intubation were significantly higher while the intubation time and number of intubation attempts significantly lower in the visual group than in the direct group. The heart rate, mean arterial pressure (MAP), or blood oxygen saturation did not differ significantly between the 2 groups 10 minutes after entering the room (T0) or after anesthesia induction (T1). MAP was significantly lower in the visual group than in the direct group during immediate intubation (T2). The heart rate and MAP were significantly lower in the visual group than in the direct group 1 minute (T3) and 5 minutes (T4) after intubation. The incidences of intubation-related complications in the visual and direct groups were 7.55% and 22.60%, showing a significant difference. Endotracheal intubation under videolaryngoscopy is safer and more effective for critically ill emergency patients than conventional direct laryngoscopy. This can improve the success rate of intubation, reduce the intubation time, and reduce its effect on hemodynamics. Therefore, it is worthy of further clinical application.

Video-Twin Technique for Airway Management, Combining Video-Intubating Stylet with Videolaryngoscope: A Case Series Report and Review of the Literature

Direct laryngoscopy (DL) and videolaryngoscopy (VL) have been the most commonly used airway management modalities in the last several decades. Meanwhile, various optional airway tools (e.g., supraglottic devices, fiberoptic bronchoscopes) have been used for alternative rescue modalities when anticipated or unexpected difficulties in airway management has occurred. In recent decades, optical stylets and video-assisted intubating stylets have become another option for difficult airway scenarios. In contrast to other approaches, we have adopted the Shikani video-assisted intubating stylet technique (VS) for both routine and difficult airway management scenarios. In this case series report, we present the video-twin technique, combining a videolaryngoscope with a video-assisted intubating stylet in various clinical case scenarios. We propose that such a combination is easy to learn and employ and is particularly beneficial in situations where an expected difficult airway (EDA) is encountered.

Effectiveness of intubation devices in patients with cervical spine immobilisation: a systematic review and network meta-analysis

BACKGROUND

Cervical spine immobilisation increases the difficulty of tracheal intubation. Many intubation devices have been evaluated in this setting, but their relative performance remains uncertain.

METHODS

MEDLINE, EMBASE, and the Cochrane Library were searched to identify randomised trials comparing two or more intubation devices in adults with cervical spine immobilisation. After critical appraisal, a random-effects network meta-analysis was used to pool and compare device performance. The primary outcome was the probability of first-attempt intubation success (first-pass success). For relative performance, the Macintosh direct laryngoscopy blade was chosen as the reference device.

RESULTS

We included 80 trials (8039 subjects) comparing 26 devices. Compared with the Macintosh, McGrath™ (odds ratio [OR]=11.5; 95% credible interval [CrI] 3.19-46.20), C-MAC D Blade™ (OR=7.44; 95% CrI, 1.06-52.50), Airtraq™ (OR=5.43; 95% CrI, 2.15-14.2), King Vision™ (OR=4.54; 95% CrI, 1.28-16.30), and C-MAC™ (OR=4.20; 95% CrI=1.28-15.10) had a greater probability of first-pass success. This was also true for the GlideScope™ when a tube guide was used (OR=3.54; 95% CrI, 1.05-12.50). Only the Airway Scope™ had a better probability of first-pass success compared with the Macintosh when manual-in-line stabilisation (MILS) was used as the immobilisation technique (OR=7.98; 95% CrI, 1.06-73.00).

CONCLUSIONS

For intubation performed with cervical immobilisation, seven devices had a better probability of first-pass success compared with the Macintosh. However, more studies using MILS (rather than a cervical collar or other alternative) are needed, which more accurately represent clinical practice.

CLINICAL TRIAL REGISTRATION

PROSPERO 2019 CRD42019158067 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158067).

Learning Curves for Two Fiberscopes in Simulated Difficult Airway Scenario With Cumulative Sum Method

INTRODUCTION

The aims of this randomized prospective mannequin study were to determine the amount of attempts required for successful intubation using different fiberscopes (Bonfils and SensaScope) by inexperienced anesthesiologists in a difficult airway scenario and to build the associated learning curves.

METHODS

Difficult airway simulation was achieved with tongue edema in mannequin. After approval of volunteers, we asked 15 anesthesiology residents without any experience with fiberscopes to intubate with each device in a random order. Intubation success (endotracheal intubation within 120 seconds), the degree of difficulty of intubation, and reality of simulation using a 10-point scale were recorded. Learning curves were generated with cumulative sum method.

RESULTS

With Bonfils, 13 volunteers were able to pass lower decision boundary with a median number of 26 [95% confidence interval (CI) = 21.4-25.9] attempts, whereas in SensaScope, the same outcome was observed in 10 residents with a median number of attempts of 26 (95% CI = 23.5-32.5). Total success rate was found significantly higher with Bonfils compared with SensaScope (550/600 vs 512/600, respectively, P < 0.001). Intubation with Bonfils was considered as less difficult compared with SensaScope [median = 4 (95% CI = 3.32-4.42) and 6 (95% CI = 4.96-6.64), P = 0.01, respectively]. The reality of the simulation was rated as a median of 5 (95% CI = 4.37-5.8).

CONCLUSIONS

Although a similar number of attempts were required to reach predetermined competency for both fiberscopes, only 10 of residents were able to obtain the targeted success using SensaScope as compared with 13 with Bonfils. Inexperienced residents found intubation via Bonfils less difficult than SensaScope. High individual variability in obtaining competency observed in this study with cumulative sum analysis underlines the importance of defining success a priori to simulation, the need for follow-up of individual progress, and the need to offer adequate trials to achieve competency. Therefore, learning opportunities should be adapted accordingly.