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Shukla A, Shanker R, Singh VK, Singh GP, Srivastava T. Non-channeled Video Laryngoscopy as an Alternative to Conventional Laryngoscopy for Intubating Adult Patients in the Intensive Care Unit. Cureus 2023; 15:e40716. [PMID: 37485208 PMCID: PMC10359833 DOI: 10.7759/cureus.40716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Background Endotracheal intubation in the intensive care unit (ICU) is often a risky procedure due to the emergency situation, unstable condition of the patient, and technical problems such as inadequate positioning. Several new techniques, such as video laryngoscopy, have been developed recently to improve the success rate of first-pass intubations and reduce complications. We conducted this study to compare a non-channeled reusable video laryngoscope BPL VL-02 (manufactured by BPL Medical Technologies, Bangalore, India) with a conventional laryngoscope for intubation of adult patients in the ICU. Methodology A total of 72 ICU patients were randomly allocated to be intubated with either conventional direct laryngoscopy via Macintosh blade (group A) or video laryngoscopy with BPL VL-02 (group B). All patients were intubated by the primary investigator and the assistant noted the following parameters: the total number of intubation attempts, total duration of intubation, assistance or alternative technique required, Cormack Lehane grading, and any complications. Results There was no significant difference in the Cormack Lehane grading, number of attempts, or complications between the two groups. On comparing the assistance required during intubation in patients, it was observed that four (11.11%) patients in group A and seven (19.44%) patients in group B needed backward, upward, and rightward pressure on the larynx assistance during intubation. In five (13.89%) patients in group B, Stylet was required during intubation. The difference was statistically significant (p = 0.0308). The video laryngoscopy group (group B) had a longer mean duration of intubation (64.36 ± 6.28 seconds) compared to group A (45.72 ± 11.45 seconds), and the difference was statistically significant (p < 0.0001). Conclusions Non-channeled video laryngoscope (BPL VL-02) is not a suitable alternative to conventional direct laryngoscopy with a Macintosh blade in terms of successful first-pass intubation, total duration of intubation, and assistance required.
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Affiliation(s)
- Aparna Shukla
- Anaesthesiology, King George's Medical University, Lucknow, IND
| | - Ravi Shanker
- Anaesthesiology, King George's Medical University, Lucknow, IND
| | - Vipin K Singh
- Anaesthesiology, King George's Medical University, Lucknow, IND
| | | | - Tanushree Srivastava
- Anaesthesiology, Integral Institute of Medical Sciences and Research, Lucknow, IND
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Jhuang BJ, Luk HN, Qu JZ, Shikani A. Video-Twin Technique for Airway Management, Combining Video-Intubating Stylet with Videolaryngoscope: A Case Series Report and Review of the Literature. Healthcare (Basel) 2022; 10:healthcare10112175. [PMID: 36360516 PMCID: PMC9690160 DOI: 10.3390/healthcare10112175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Bo-Jyun Jhuang
- Department of Anesthesia, Hualien Tzuchi Hospital, Hualien 97002, Taiwan
| | - Hsiang-Ning Luk
- Department of Anesthesia, Hualien Tzuchi Hospital, Hualien 97002, Taiwan
- Bio-Math Laboratory, Department of Financial Engineering, Providence University, Taichung 43301, Taiwan
- Correspondence:
| | - Jason Zhensheng Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Alan Shikani
- Division of Otolaryngology-Head and Neck Surgery, LifeBridge Sinai Hospital, Baltimore, MD 21218, USA
- Division of Otolaryngology-Head and Neck Surgery, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
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Ho CH, Chen LC, Hsu WH, Lin TY, Lee M, Lu CW. A Comparison of McGrath Videolaryngoscope versus Macintosh Laryngoscope for Nasotracheal Intubation: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11092499. [PMID: 35566626 PMCID: PMC9101392 DOI: 10.3390/jcm11092499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background: In this study, it was shown that the routine use of McGrath videolaryngoscopy may improve intubation success rates. The benefits to using a videolaryngoscope in nasotracheal intubation were also demonstrated. However, no solid evidence concerning the effectiveness of the use of McGrath videolaryngoscopes in nasotracheal intubation has previously been reported. As a result, we questioned whether, in adult patients who underwent oral and maxillofacial surgeries with nasotracheal intubation (P), the use of a McGrath videolaryngoscope (I) compared with a Macintosh laryngoscope (C) could reduce the intubation time, improve glottis visualization to a score of classification 1 in the Cormack–Lehane classification system, and improve the first-attempt success rate (O). The secondary outcomes measured were the rate of the use of Magill forceps and the external laryngeal pressure (BURP) maneuver used. Methods: An extensive literature search was conducted using databases. Only randomized controlled trials that compared the McGrath videolaryngoscopy and Macintosh laryngoscopy techniques in nasotracheal intubation in adult patients were included. Results: Five articles met the inclusion criteria and were included in the final analysis (n = 331 patients). The results showed a significant decrease in intubation time and a higher rate of classification 1 scores in the Cormack–Lehane classification system, but no difference in the first-attempt success rates were found between the McGrath group and the Macintosh group. Decreases in the rate of the use of Magill forceps and the use of the external laryngeal pressure maneuver were also found in the pooled analysis. With regard to the overall risk of bias, the selected trials were classified to have at least a moderate risk of bias, because none of the trials could blind the operator to the type of laryngoscope used. Conclusions: Our analysis suggests that the use of a McGrath videolaryngoscope in nasotracheal intubation resulted in shorter intubation times, improved views of the glottis and similar first-success rates in adult patients who received general anesthesia for dental, oral, maxillofacial, or head and neck cancer surgery, and also reduced the use of Magill forceps and the BURP maneuver.
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Affiliation(s)
- Chia-Hao Ho
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Li-Chung Chen
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Wen-Hao Hsu
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
| | - Tzu-Yu Lin
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung University College of Medicine, Chiayi Chang Gung Memorial Hospital, Puzi City, Chiayi 613, Taiwan
- Correspondence: (M.L.); (C.-W.L.); Tel.: +886-2-89667000 (ext. 2383) (M.L. & C.-W.L.); Fax: +886-2-23680782 (M.L. & C.-W.L.)
| | - Cheng-Wei Lu
- Department of Anesthesiology, Far Eastern Memorial Hospital, Banqiao Dist., New Taipei City 220, Taiwan; (C.-H.H.); (L.-C.C.); (W.-H.H.); (T.-Y.L.)
- Department of Mechanical Engineering, Yuan Ze University, Taoyuan 320, Taiwan
- Correspondence: (M.L.); (C.-W.L.); Tel.: +886-2-89667000 (ext. 2383) (M.L. & C.-W.L.); Fax: +886-2-23680782 (M.L. & C.-W.L.)
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Moucharite MA, Zhang J, Giffin R. Factors and Economic Outcomes Associated with Documented Difficult Intubation in the United States. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:227-239. [PMID: 33833535 PMCID: PMC8021135 DOI: 10.2147/ceor.s304037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/12/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose Establishing good mechanical ventilation is a critical component and prerequisite to a wide range of surgical and medical interventions. Yet difficulties in intubating patients, and a variety of associated complications, are well documented. The economic burden resulting from difficult intubation (DI), however, is not well understood. The current study examines the economic burden of documented DI during inpatient surgical admissions and explores factors that are associated with DI. Patients and Methods Using data from the Premier Healthcare Database, adult patients with inpatient surgical admissions between January 1, 2016 and December 31, 2018 were selected. International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) diagnosis codes were used to classify the patients into matched cohorts of DI and non-DI patients. Results Patients in the DI group have mean inpatient costs and intensive care unit (ICU) costs that are substantially higher than patients without difficult intubations ($14,468 and $4,029 higher, respectively). Mean hospital length of stay and ICU length of stay were 3.8 days and 2.0 days longer, respectively (all p<0.0001, except ICU cost p=0.0001) in the DI group. Obesity, other chronic conditions, and larger hospital size were significantly associated with DI. Conclusion DI is associated with higher average cost and longer average length of stay.
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Affiliation(s)
| | - Jianying Zhang
- Healthcare Economics Outcomes Research, Medtronic, Mansfield, MA, USA
| | - Robert Giffin
- Healthcare Economics Outcomes Research, Medtronic, Mansfield, MA, USA
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Pius J, Noppens RR. Learning curve and performance in simulated difficult airway for the novel C-MAC® video-stylet and C-MAC® Macintosh video laryngoscope: A prospective randomized manikin trial. PLoS One 2020; 15:e0242154. [PMID: 33211728 PMCID: PMC7676690 DOI: 10.1371/journal.pone.0242154] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022] Open
Abstract
Difficult airways can be managed with a range of devices, with video laryngoscopes (VLs) being the most common. The C-MAC® Video-Stylet (VS; Karl-Storz Germany), a hybrid between a flexible and a rigid intubation endoscope, has been recently introduced. The aim of this study is to investigate the performance of the VS compared to a VL (C-MAC Macintosh blade, Karl-Storz Germany) with regards to the learning curve for each device and its ability to manage a simulated difficult airway manikin. This is a single-center, prospective, randomized, crossover study involving twenty-one anesthesia residents performing intubations on a Bill 1™ (VBM, Germany) airway manikin model. After a standardized introduction, six randomized attempts with VL and VS were performed on the manikin. This was followed by intubation in a simulated difficult airway (cervical collar and inflated tongue) with both devices in a randomized fashion. The primary end-point of this study was the total time to intubation. All continuous variables were expressed as the median [interquartile range] and analyzed using the Mann-Whitney U test. A 2-way ANOVA with Bonferroni's post hoc test was used to compare both devices at each trial. All reported p values are two sided. The median total time to intubation on a simulated difficult airway was faster with the VS compared to VL (17 [13.5-25] sec vs 23 [18.5-26.5] sec, respectively; 95% CI; P = 0.031). Additionally, on a normal airway manikin, the VS has a comparable learning curve to the VL. In this manikin-based study, the novel VS was comparable to the VL in terms of learning curve in a normal airway. In a simulated difficult airway, the total time to intubation, though likely not clinically relevant, was faster with the VS to the VL. However, given the above findings, this study justifies further human clinical trials with the VS to see if similar benefits-faster time to intubation and similar learning curve to VL-are replicated clinically.
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Affiliation(s)
- James Pius
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, LHSC- University Hospital, London, Ontario, Canada
| | - Ruediger R. Noppens
- Department of Anesthesia & Perioperative Medicine, University of Western Ontario, LHSC- University Hospital, London, Ontario, Canada
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Ott T, Stracke J, Sellin S, Kriege M, Toenges G, Lott C, Kuhn S, Engelhard K. Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms. BMJ Open 2019; 9:e030430. [PMID: 31767584 PMCID: PMC6887030 DOI: 10.1136/bmjopen-2019-030430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES During a 'cannot intubate, cannot oxygenate' situation, asphyxia can lead to cardiac arrest. In this stressful situation, two complex algorithms facilitate decision-making to save a patient's life: difficult airway management and cardiopulmonary resuscitation. However, the extent to which competition between the two algorithms causes conflicts in the execution of pivotal treatment remains unknown. Due to the rare incidence of this situation and the very low feasibility of such an evaluation in clinical reality, we decided to perform a randomised crossover simulation research study. We propose that even experienced healthcare providers delay cricothyrotomy, a lifesaving approach, due to concurrent cardiopulmonary resuscitation in a 'cannot intubate, cannot oxygenate' situation. DESIGN Due to the rare incidence and dynamics of such a situation, we conducted a randomised crossover simulation research study. SETTING We collected data in our institutional simulation centre between November 2016 and November 2017. PARTICIPANTS We included 40 experienced staff anaesthesiologists at our tertiary university hospital centre. INTERVENTION The participants treated two simulated patients, both requiring cricothyrotomy: one patient required cardiopulmonary resuscitation due to asphyxia, and one patient did not require cardiopulmonary resuscitation. Cardiopulmonary resuscitation was the intervention. Participants were evaluated by video records. PRIMARY OUTCOME MEASURES The difference in 'time to ventilation through cricothyrotomy' between the two situations was the primary outcome measure. RESULTS The results of 40 participants were analysed. No carry-over effects were detected in the crossover design. During cardiopulmonary resuscitation, the median time to ventilation was 22 s (IQR 3-40.5) longer than that without cardiopulmonary resuscitation (p=0.028), including the decision-making time. CONCLUSION Cricothyrotomy, which is the most crucial treatment for cardiac arrest in a 'cannot intubate, cannot oxygenate' situation, was delayed by concurrent cardiopulmonary resuscitation. If cardiopulmonary resuscitation delays cricothyrotomy, it should be interrupted to first focus on cricothyrotomy.
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Affiliation(s)
- Thomas Ott
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Jascha Stracke
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Susanna Sellin
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Carsten Lott
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Sebastian Kuhn
- Department of Orthopaedics and Traumatology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
| | - Kristin Engelhard
- Department of Anaesthesiology, Johannes Gutenberg Universitat Mainz, Mainz, Germany
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Rowland MJ, Urman RD, Xu X, Ehrenfeld JM, Preiss DA, Vacanti JC. The Impact of Airway Technique on Anesthesia Control Time. J Med Syst 2019; 43:72. [PMID: 30746553 DOI: 10.1007/s10916-019-1191-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/30/2019] [Indexed: 11/24/2022]
Abstract
Few studies have examined the impact of video laryngoscopy (VL) on operating room efficiency. We hypothesized that VL reduces anesthesia control time (ACT), a metric of anesthesia efficiency, compared with fiberoptic intubation (FOI) in potentially difficult airways, but that direct laryngoscopy (DL) remains more efficient in routine cases. We performed a multi-institutional, retrospective chart review of anesthetic cases from 2015 to 2016. Cases were compared based on choice of airway technique (laryngeal mask airway [LMA], DL, VL or FOI) and ACT. Generalized linear models with gamma distribution and log link were then used to model the data to control for variables including ASA physical status (PS), Mallampati (MP) score, body mass index, and presence of a trainee. ACT was analyzed for 32,542 cases. LMA insertion was associated with a median ACT of 10 min (CI 8-14 min), DL 14 min (CI 11-18 min), VL 17 min (CI 13-21 min) and FOI 20 min (CI 14.5-26 min). Modeling confirmed these results when controlling for variables expected to increase the ACT. However, modeling also revealed that presence of a trainee minimizes the increase in ACT for cases using VL or FOI. Use of VL in patients with a high MP score may improve anesthesia efficiency in the operating room. ASA PS, MP score, and presence of a trainee are all associated with an increased ACT. Trainee presence with both FOI and VL was associated with reduced increases in ACT for these devices.
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Affiliation(s)
- Matthew J Rowland
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA.
| | - Xinling Xu
- Department of Anesthesia, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jesse M Ehrenfeld
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - David A Preiss
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
| | - Joshua C Vacanti
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA
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