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Boulton AJ, Smith E, Yasin A, Moreton J, Mendonca C. Tracheal tube introducer-associated airway trauma: a systematic review. Anaesthesia 2024; 79:1091-1101. [PMID: 39073144 DOI: 10.1111/anae.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Tracheal tube introducers are recommended in airway management guidelines and are used increasingly as videolaryngoscopy becomes more widespread. This systematic review aimed to summarise the published literature concerning tracheal tube introducer-associated airway trauma. METHODS PubMed, EMBASE and CINAHL databases were searched using pre-determined criteria. Two authors independently assessed search results and performed data extraction and risk of bias assessments. RESULTS We included 16 randomised controlled trials and five observational studies involving 10,797 patients. There was heterogeneity in patient characteristics, airway manipulation, and airway trauma definition and measurement. One study investigated hyperangulated videolaryngoscopy. The standard stylet was the most commonly reported introducer, followed by bougie and stylets with additional features such as video or lighted tip. Airway trauma resulted in low harm and most frequently involved injuries to the upper airway, followed by laryngeal and tracheobronchial injuries. Eighteen studies were comparative and reported a reduction in airway trauma incidence when an introducer was used, with the exception of the standard stylet. Median (IQR [range]) pooled incidence of airway trauma associated with standard stylets was 13.1% (4.2-31.4 [0.5-79.2])% and with bougies was 5.4% (0.4-49.9 [0.0-68.0])%. The risk of bias of included studies was variable and many randomised trials were found to be at high risk due to non-robust measurement of the outcome. CONCLUSIONS Stylets might be associated with an increased risk of airway trauma compared with other devices or when no stylet was used, though the quality of evidence is modest. However, other introducers appear to be safe and reduce the risk of airway trauma.
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Affiliation(s)
- Adam J Boulton
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Edward Smith
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ambreen Yasin
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Joseph Moreton
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Cyprian Mendonca
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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2
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Galway U, Abdelmalak BB. Not all tracheal tube introducers are created equal. Anaesthesia 2024; 79:1013-1016. [PMID: 39073132 DOI: 10.1111/anae.16374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Ursula Galway
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Basem B Abdelmalak
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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3
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Orrock JL, Ward PA, McNarry AF. Routine Use of Videolaryngoscopy in Airway Management. Int Anesthesiol Clin 2024; 62:48-58. [PMID: 39233571 DOI: 10.1097/aia.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Tracheal intubation is a fundamental facet of airway management, for which the importance of achieving success at the first attempt is well recognized. Failure to do so can lead to significant morbidity and mortality if there is inadequate patient oxygenation by alternate means. The evidence supporting the benefits of a videolaryngoscope in attaining this objective is now overwhelming (in adults). This has led to its increasing recognition in international airway management guidelines and its promotion from an occasional airway rescue tool to the first-choice device during routine airway management. However, usage in clinical practice does not currently reflect the increased worldwide availability that followed the upsurge in videolaryngoscope purchasing during the coronavirus disease 2019 pandemic. There are a number of obstacles to widespread adoption, including lack of adequate training, fears over de-skilling at direct laryngoscopy, equipment and cleaning costs, and concerns over the environmental impact, among others. It is now clear that in order for patients to benefit maximally from the technology and for airway managers to fully appreciate its role in everyday practice, proper training and education are necessary. Recent research evidence has addressed some existing barriers to default usage, and the emergence of techniques such as awake videolaryngoscopy and video-assisted flexible (bronchoscopic) intubation has also increased the scope of clinical application. Future studies will likely further confirm the superiority of videolaryngoscopy over direct laryngoscopy, therefore, it is incumbent upon all airway managers (and their teams) to gain expertise in videolaryngoscopy and to use it routinely in their everyday practice..
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Affiliation(s)
- Jane Louise Orrock
- Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, UK
| | | | - Alistair Ferris McNarry
- Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, UK
- Department of Anaesthesia, Western General Hospital, NHS Lothian, Edinburgh, UK
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4
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Penders R, Kelly FE, Cook TM. Universal C-MAC® videolaryngoscope use in adult patients: a single-centre experience. Anaesth Rep 2024; 12:e12314. [PMID: 39100912 PMCID: PMC11292117 DOI: 10.1002/anr3.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/06/2024] Open
Abstract
Universal use of Storz C-MAC® videolaryngoscopes was implemented for adult tracheal intubations in the operating theatres, intensive care unit and emergency department at Royal United Hospitals Bath NHS Foundation Trust in 2017. We report data from 1099 intubations from March 2020 to March 2022, collected contemporaneously and anonymously using a smartphone app, representing an estimated 18% of intubations in operating theatres and 30% of intubations in other locations during this period. Intubation success was 100%. The first-pass success rate was 87.3% overall: 87% with a Macintosh videolaryngoscope, 92% with a hyperangulated videolaryngoscope and 81% for users with ≤ 20 previous uses. First-pass success without complications was 87% overall: 87% in operating theatres (836/962), 93% in the emergency department (38/41) and 83% in the intensive care unit (73/88). Complications occurred during 0.6% of intubations: 0/962 in operating theatres and 7/137 in non-theatre locations. The rate of complications was unaltered by blade type (Macintosh 5/994 vs. hyperangulated 2/105, p = 0.14); intubator experience with the device (≤ 20 previous clinical uses 2/260 vs. > 20 previous uses 5/832, p = 0.67) and use of airborne personal protective equipment (PPE 6/683 vs. no-PPE 1/410, p = 0.27). Complication rates increased outside theatres (theatres 0/963 vs. non-theatre 7/136, p < 0.001) and during rapid sequence induction (RSI 6/379 (1.6%) vs. non-RSI 1/720 (0.1%), p = 0.008).
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Affiliation(s)
- R. Penders
- Royal United Hospitals Bath NHS Foundation TrustBathUK
| | - F. E. Kelly
- Royal United Hospitals Bath NHS Foundation TrustBathUK
| | - T. M. Cook
- Royal United Hospitals Bath NHS Foundation TrustBathUK
- School of MedicineUniversity of BristolUK
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5
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Taboada M, Estany-Gestal A, Rial M, Cariñena A, Martínez A, Selas S, Eiras M, Veiras S, Ferreiroa E, Cardalda B, López C, Calvo A, Fernández J, Álvarez J, Alcántara JM, Seoane-Pillado T. Impact of Universal Use of the McGrath Videolaryngoscope as a Device for All Intubations in the Cardiac Operating Room. A Prospective Before-After VIDEOLAR-CAR Study. J Cardiothorac Vasc Anesth 2024; 38:1499-1505. [PMID: 38580479 DOI: 10.1053/j.jvca.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/02/2024] [Accepted: 03/11/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Tracheal intubation in cardiac surgery patients has a higher incidence of difficult laryngoscopic views compared with patients undergoing other types of surgery. The authors hypothesized that using the McGrath Mac videolaryngoscope as the first intubation option for cardiac surgery patients improves the percentage of patients with "easy intubation" compared with using a direct Macintosh laryngoscope. DESIGN A prospective, observational, before-after study. SETTING At a tertiary-care hospital. PARTICIPANTS One thousand one hundred nine patients undergoing cardiac surgery. INTERVENTION Consecutive patients undergoing cardiac surgery were intubated using, as the first option, a Macintosh laryngoscope (preinterventional phase) or a McGrath Mac videolaryngoscope (interventional phase). MEASUREMENTS AND MAIN RESULTS The main objective was to assess whether the use of the McGrath videolaryngoscope, as the first intubation option, improves the percentage of patients with "easy intubation," defined as successful intubation on the first attempt, modified Cormack-Lehane grades of I or IIa, and the absence of the need for adjuvant airway devices. A total of 1,109 patients were included, 801 in the noninterventional phase and 308 in the interventional phase. The incidence of "easy intubation" was 93% in the interventional phase versus 78% in the noninterventional phase (p < 0.001). First-success-rate intubation was higher in the interventional phase (304/308; 98.7%) compared with the noninterventional phase (754/801, 94.1%; p = 0.005). Intubation in the interventional phase showed decreases in the incidence of difficult laryngoscopy (12/308 [3.9%] v 157/801 [19.6%]; p < 0.001), as well as moderate or difficult intubation (5/308 [1.6%] v 57/801 [7.1%]; p < 0.001). CONCLUSIONS The use of the McGrath videolaryngoscope as the first intubation option for tracheal intubation in cardiac surgery improves the percentage of patients with "easy" intubation," increasing glottic view and first-success-rate intubation and decreasing the incidence of moderate or difficult intubation.
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Affiliation(s)
- Manuel Taboada
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain.
| | - Ana Estany-Gestal
- Research Methodology Unit. Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago, Spain
| | - María Rial
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Agustín Cariñena
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Adrián Martínez
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Salomé Selas
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - María Eiras
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Sonia Veiras
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Esteban Ferreiroa
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Borja Cardalda
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Carmen López
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Andrea Calvo
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Jorge Fernández
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Julián Álvarez
- Department of Anaesthesiology, University Clinical Hospital of Santiago, Santiago de Compostela, Spain
| | - Jorge Miguel Alcántara
- Research Methodology Unit. Fundación Instituto de Investigaciones Sanitarias (FIDIS), Santiago, Spain
| | - Teresa Seoane-Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, A Coruña, Spain
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Bacher V, Németh M, Rendeki S, Tornai B, Rozanovic M, Pankaczi A, Oláh J, Farkas J, Chikhi M, Schlégl Á, Maróti P, Nagy B. Comparison of Macintosh Laryngoscope, King Vision ®, VividTrac ®, AirAngel Blade ®, and a Custom-Made 3D-Printed Video Laryngoscope for Difficult and Normal Airways in Mannequins by Novices-A Non-Inferiority Trial. J Clin Med 2024; 13:3213. [PMID: 38892925 PMCID: PMC11173105 DOI: 10.3390/jcm13113213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Endotracheal intubation (ETI) is a cornerstone of airway management. The gold standard device for ETI is still the direct laryngoscope (DL). However, video laryngoscopes (VLs) are now also widely available and have several proven advantages. The VL technique has been included in the major airway management guidelines. During the COVID-19 pandemic, supply chain disruption has raised demand for 3D-printed medical equipment, including 3D-printed VLs. However, studies on performance are only sparsely available; thus, we aimed to compare 3D-printed VLs to the DL and other VLs made with conventional manufacturing technology. Methods: Forty-eight medical students were recruited to serve as novice users. Following brief, standardized training, students executed ETI with the DL, the King Vision® (KV), the VividTrac® (VT), the AirAngel Blade® (AAB), and a custom-made 3D-printed VL (3DVL) on the Laerdal® airway management trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma, and user satisfaction. Results: The KV and VT are proved to be superior (p < 0.05) to the DL in both scenarios. The 3DVL's performance was similar (p > 0.05) or significantly better than that of the DL and mainly non-inferior (p > 0.05) compared to the KV and VT in both scenarios. Regardless of the scenario, the AAB proved to be inferior (p < 0.05) even to the DL in the majority of the variables. The differences between the devices were more pronounced in the difficult airway scenario. The user satisfaction scores were in concordance with the aforementioned performance of the scopes. Conclusions: Based upon our results, we cannot recommend the AAB over the DL, KV, or VT. However, as the 3DVL showed, 3D printing indeed can provide useful or even superior VLs, but prior to clinical use, meticulous evaluation might be recommended.
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Affiliation(s)
- Viktor Bacher
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
| | - Márton Németh
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Szilárd Rendeki
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
| | - Balázs Tornai
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Martin Rozanovic
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Andrea Pankaczi
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - János Oláh
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - József Farkas
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- Department of Anatomy, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Melánia Chikhi
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
| | - Ádám Schlégl
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- Department of Orthopedics, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Péter Maróti
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
- 3D Printing & Visualization Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary
| | - Bálint Nagy
- Department of Anesthesiology and Intensive Medicine, Medical School, University of Pecs, H-7624 Pecs, Hungary; (V.B.); (M.N.); (S.R.); (B.T.); (A.P.); (M.C.); (B.N.)
- Medical Skills Education and Innovation Centre, Medical School, University of Pécs, H-7624 Pecs, Hungary; (J.F.); (Á.S.)
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McNarry AF, Ward P, Silas U, Saunders R, Saunders SJ. Macintosh-style videolaryngoscope use for tracheal intubation in elective surgical patients revisited: a sub-analysis of the 2022 Cochrane review data. Patient Saf Surg 2024; 18:20. [PMID: 38807147 PMCID: PMC11134739 DOI: 10.1186/s13037-024-00402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/18/2024] [Indexed: 05/30/2024] Open
Abstract
The Cochrane systematic review and meta-analysis published in 2022 that compared videolaryngoscopy (VL) with direct laryngoscopy (DL) for facilitating tracheal intubation in adults found that all three types of VL device (Macintosh-style, hyper-angulated and channeled) reduced the risk of failed intubation and increased the likelihood of first-pass success. We report the findings of a subgroup re-analysis of the 2022 Cochrane meta-analysis data focusing on the Macintosh-style VL group. This was undertaken to establish whether sufficient evidence exists to guide airway managers in making purchasing decisions for their local institutions based upon individual device-specific performance. This re-analysis confirmed the superiority of Macintosh-style VL over Macintosh DL in elective surgical patients, with similar efficacy demonstrated between the Macintosh-style VL devices examined. Thus, when selecting which VL device(s) to purchase for their hospital, airway managers decisions are likely to remain focused upon issues such as financial costs, portability, cleaning schedules and previous device experience.
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Affiliation(s)
- Alistair F McNarry
- Department of Anaesthesia, St John's Hospital, NHS Lothian, Edinburgh, UK.
| | - Patrick Ward
- Department of Anaesthesia, St John's Hospital, NHS Lothian, Edinburgh, UK
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8
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Wylie NW, Durrant EL, Phillips EC, De Jong A, Schoettker P, Kawagoe I, de Pinho Martins M, Zapatero J, Graham C, McNarry AF. Videolaryngoscopy use before and after the initial phases of the COVID-19 pandemic: The report of the VL-iCUE survey with responses from 96 countries. Eur J Anaesthesiol 2024; 41:296-304. [PMID: 37962353 DOI: 10.1097/eja.0000000000001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The potential benefit of videolaryngoscopy use in facilitating tracheal intubation has already been established, however its use was actively encouraged during the COVID-19 pandemic as it was likely to improve intubation success and increase the patient-operator distance. OBJECTIVES We sought to establish videolaryngoscopy use before and after the early phases of the pandemic, whether institutions had acquired new devices during the COVID-19 pandemic, and whether there had been teaching on the devices acquired. DESIGN We designed a survey with 27 questions made available via the Joint Information Scientific Committee JISC online survey platform in English, French, Spanish, Chinese, Japanese and Portuguese. This was distributed through 18 anaesthetic and airway management societies. SETTING The survey was open for 54 to 90 days in various countries. The first responses were logged on the databases on 28 October 2021, with all databases closed on 26 January 2022. Reminders to participate were sent at the discretion of the administering organisations. PARTICIPANTS All anaesthetists and airway managers who received the study were eligible to participate. MAIN OUTCOME MEASURES Videolaryngoscopy use before the COVID-19 pandemic and at the time of the survey. RESULTS We received 4392 responses from 96 countries: 944/4336 (21.7%) were from trainees. Of the 3394 consultants, 70.8% (2402/3394) indicated no change in videolaryngoscopy use, 19.9% (675/3394) increased use and 9.3% (315/3393) reduced use. Among trainees 65.5% (618/943) reported no change in videolaryngoscopy use, 27.7% (261/943) increased use and 6.8% (64/943) reduced use. Overall, videolaryngoscope use increased by 10 absolute percentage points following the pandemic. CONCLUSIONS Videolaryngoscopy use increased following the early phase of the COVID-19 pandemic but this was less than might have been expected.
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Affiliation(s)
- Nia W Wylie
- From the South East Scotland School of Anaesthesia, NHS Lothian, Edinburgh UK (NWW, ELD, ECP), Department of Anesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France (ADJ), Department of Anesthesiology, Lausanne University Hospital, Switzerland (PS), Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Graduate School of Medicine, Japan (IK), Department of Anesthesia, Critical Care and Pain Medicine, Central Hospital of the Military Police of Rio de Janeiro, Rio de Janeiro, Brazil (MP), Hospital Clínic de Barcelona, Spain (JZ), Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, UK (CG), Western General and St Johns Hospitals, NHS Lothian, Edinburgh UK (AFMN)
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9
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Merola R, Mancino D, Vargas M. Videolaryngoscopy versus direct laryngoscopy: a bibliometric analysis. Br J Anaesth 2024; 132:166-168. [PMID: 37925267 DOI: 10.1016/j.bja.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
- Raffaele Merola
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Dalila Mancino
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Vargas
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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10
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Lyons C. Laryngoscopy trials: who is putting the tube in the oesophagus? Anaesthesia 2023; 78:1517-1519. [PMID: 37462101 DOI: 10.1111/anae.16102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 11/08/2023]
Affiliation(s)
- C Lyons
- Great Ormond Street Hospital for Children, London, UK
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11
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Heidegger T, Asai T. Fibreoptic intubation: a commitment to an indispensable technique. Br J Anaesth 2023; 131:793-796. [PMID: 37479592 DOI: 10.1016/j.bja.2023.06.039] [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: 06/01/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 07/23/2023] Open
Abstract
Recent evidence has shown that fibreoptic intubation is still an indispensable technique for safe management of predicted difficult airways, despite the implementation of new technologies such as videolaryngoscopy. It is therefore our obligation as anaesthesia societies and as practicing anaesthetists to offer this technique to our patients in clearly designated situations.
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Affiliation(s)
- Thomas Heidegger
- Department of Anaesthesia, Spital Grabs, Grabs, Switzerland; Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Centre, Koshigaya, Saitama, Japan
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12
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Russotto V, Lascarrou JB, Tassistro E, Parotto M, Antolini L, Bauer P, Szułdrzyński K, Camporota L, Putensen C, Pelosi P, Sorbello M, Higgs A, Greif R, Grasselli G, Valsecchi MG, Fumagalli R, Foti G, Caironi P, Bellani G, Laffey JG, Myatra SN. Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study. Br J Anaesth 2023; 131:607-616. [PMID: 37208282 DOI: 10.1016/j.bja.2023.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. METHODS This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy. RESULTS Of 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P=0.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P<0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05-1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95-1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60-1.02). CONCLUSIONS In critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events. CLINICAL TRIAL REGISTRATION NCT03616054.
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Affiliation(s)
- Vincenzo Russotto
- Department of Anesthesia and Critical Care, University Hospital San Luigi Gonzaga, University of Turin, Italy
| | | | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Laura Antolini
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Philippe Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Konstanty Szułdrzyński
- Department of Anesthesiology and Intensive Care, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Luigi Camporota
- Health Centre for Human and Applied Physiological Sciences, Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Massimiliano Sorbello
- Anesthesia and Intensive Care, Policlinico Vittorio Emanuele San Marco University Hospital, Catania, Italy
| | - Andy Higgs
- Anaesthesia and Intensive Care Medicine, Warrington Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Giacomo Grasselli
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria G Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Pietro Caironi
- Department of Anesthesia and Critical Care, University Hospital San Luigi Gonzaga, University of Turin, Italy
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - John G Laffey
- Regenerative Medicine Institute at CURAM Centre for Medical Devices, School of Medicine, University of Galway, Galway, Ireland; Anesthesia and Intensive Care Medicine, University Hospital Galway, Galway, Ireland.
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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13
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Saul SA, Ward PA, McNarry AF. Airway Management: The Current Role of Videolaryngoscopy. J Pers Med 2023; 13:1327. [PMID: 37763095 PMCID: PMC10532647 DOI: 10.3390/jpm13091327] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over "de-skilling" at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research.
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Affiliation(s)
- Sophie A. Saul
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Patrick A. Ward
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Alistair F. McNarry
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
- Western General Hospital, Crewe Road South, NHS Lothian, Edinburgh EH4 2XU, UK
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14
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Asai T, Jagannathan N. Videolaryngoscopy Is Extremely Valuable, But Should It Be the Standard for Tracheal Intubation? Anesth Analg 2023; 136:679-682. [PMID: 36928153 DOI: 10.1213/ane.0000000000006313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Takashi Asai
- From the Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Narasimhan Jagannathan
- Phoenix Children's Hospital, Phoenix, Arizona
- University of Arizona School of Medicine, Phoenix, Arizona
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15
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De Jong A, Pouzeratte Y, Sfara T, Jaber S. Use of videolaryngoscopy as the first option for all tracheal intubations: not so fast. Response to Br J Anaesth 2023; 130: e12-e13. Br J Anaesth 2023; 130:e187-e189. [PMID: 36435665 DOI: 10.1016/j.bja.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Audrey De Jong
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France; PhyMedExp, INSERM U1046, CNRS UMR, Montpellier, France
| | - Yvan Pouzeratte
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France
| | - Thomas Sfara
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Montpellier, France; PhyMedExp, INSERM U1046, CNRS UMR, Montpellier, France.
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16
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Mirrakhimov AE, Torgeson E. Use of videolaryngoscopy as the first option for all tracheal intubations: not so fast. Comment on Br J Anaesth 2022; 129: 624-634. Br J Anaesth 2023; 130:e12-e13. [PMID: 36307273 DOI: 10.1016/j.bja.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Aibek E Mirrakhimov
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Eli Torgeson
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, NM, USA
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