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Liu Y, Zhang Y, Zhu B, Xu W, Yang Y, Zou Z. Development of endotracheal intubation devices for patients with tumors. Am J Cancer Res 2022; 12:2433-2446. [PMID: 35812038 PMCID: PMC9251697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023] Open
Abstract
The incidence and mortality of malignant tumors are rapidly increasing in the world. Patients with malignant tumors often need surgery for treatment. Endotracheal intubation is a necessary technique for surgical patients undergoing general anesthesia. It is also an important procedure for critically ill patients in the emergency room or ICU. Most patients with head and neck tumors and some specific patients have difficult airways, so the operator may need to use a variety of intubation devices. The commonly used devices for endotracheal intubation include endotracheal tube, direct laryngoscope, video laryngoscope, introducer, optical stylet, fiberoptic bronchoscope. With the advancement in science and technology, the endotracheal intubation devices have been improved, and new devices have been developed. These devices are safer and more feasible in clinical practice. In this review, we summarized the features and applications of some of the currently used devices. Each device has its own uniqueness and meets different needs. The devices and their respective properties are strongly suggested to be mastered by the anesthesiologists as well as related staffs, so as to select the appropriate device for intubation.
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Affiliation(s)
- Yang Liu
- School of Anesthesiology, Naval Medical UniversityShanghai 200433, China
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical UniversityShanghai 200003, China
| | - Yang Zhang
- Department of Anesthesiology, Tianjin Fourth Central HospitalNo. 1 Zhongshan Road, Tianjin 300140, China
| | - Bin Zhu
- Department of Anesthesiology, The People’s Hospital of Suzhou New DistrictNo. 95 Huashan Road, Suzhou 215129, Jiangsu, China
| | - Wenyun Xu
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical UniversityShanghai 200003, China
| | - Yi Yang
- Department of Anesthesiology, The People’s Hospital of Suzhou New DistrictNo. 95 Huashan Road, Suzhou 215129, Jiangsu, China
| | - Zui Zou
- School of Anesthesiology, Naval Medical UniversityShanghai 200433, China
- Department of Anesthesiology, Second Affiliated Hospital of Naval Medical UniversityShanghai 200003, China
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Driver BE, Semler MW, Self WH, Ginde AA, Trent SA, Gandotra S, Smith LM, Page DB, Vonderhaar DJ, West JR, Joffe AM, Mitchell SH, Doerschug KC, Hughes CG, High K, Landsperger JS, Jackson KE, Howell MP, Robison SW, Gaillard JP, Whitson MR, Barnes CM, Latimer AJ, Koppurapu VS, Alvis BD, Russell DW, Gibbs KW, Wang L, Lindsell CJ, Janz DR, Rice TW, Prekker ME, Casey JD. Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA 2021; 326:2488-2497. [PMID: 34879143 PMCID: PMC8655668 DOI: 10.1001/jama.2021.22002] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE For critically ill adults undergoing emergency tracheal intubation, failure to intubate the trachea on the first attempt occurs in up to 20% of cases and is associated with severe hypoxemia and cardiac arrest. Whether using a tracheal tube introducer ("bougie") increases the likelihood of successful intubation compared with using an endotracheal tube with stylet remains uncertain. OBJECTIVE To determine the effect of use of a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt. DESIGN, SETTING, AND PARTICIPANTS The Bougie or Stylet in Patients Undergoing Intubation Emergently (BOUGIE) trial was a multicenter, randomized clinical trial among 1102 critically ill adults undergoing tracheal intubation in 7 emergency departments and 8 intensive care units in the US between April 29, 2019, and February 14, 2021; the date of final follow-up was March 14, 2021. INTERVENTIONS Patients were randomly assigned to use of a bougie (n = 556) or use of an endotracheal tube with stylet (n = 546). MAIN OUTCOMES AND MEASURES The primary outcome was successful intubation on the first attempt. The secondary outcome was the incidence of severe hypoxemia, defined as a peripheral oxygen saturation less than 80%. RESULTS Among 1106 patients randomized, 1102 (99.6%) completed the trial and were included in the primary analysis (median age, 58 years; 41.0% women). Successful intubation on the first attempt occurred in 447 patients (80.4%) in the bougie group and 453 patients (83.0%) in the stylet group (absolute risk difference, -2.6 percentage points [95% CI, -7.3 to 2.2]; P = .27). A total of 58 patients (11.0%) in the bougie group experienced severe hypoxemia, compared with 46 patients (8.8%) in the stylet group (absolute risk difference, 2.2 percentage points [95% CI, -1.6 to 6.0]). Esophageal intubation occurred in 4 patients (0.7%) in the bougie group and 5 patients (0.9%) in the stylet group, pneumothorax was present after intubation in 14 patients (2.5%) in the bougie group and 15 patients (2.7%) in the stylet group, and injury to oral, glottic, or thoracic structures occurred in 0 patients in the bougie group and 3 patients (0.5%) in the stylet group. CONCLUSIONS AND RELEVANCE Among critically ill adults undergoing tracheal intubation, use of a bougie did not significantly increase the incidence of successful intubation on the first attempt compared with use of an endotracheal tube with stylet. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03928925
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Affiliation(s)
- Brian E. Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Matthew W. Semler
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wesley H. Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Institute for Clinical and Translational Sciences, Nashville, Tennessee
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Stacy A. Trent
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado
| | - Sheetal Gandotra
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham
| | - Lane M. Smith
- Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - David B. Page
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham
- Department of Emergency Medicine, University of Alabama at Birmingham
| | - Derek J. Vonderhaar
- Department of Pulmonary and Critical Care Medicine, Ochsner Health System, New Orleans, Louisiana
- Section of Emergency Medicine, Louisiana State University School of Medicine, New Orleans
| | - Jason R. West
- Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York
| | - Aaron M. Joffe
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | | | | | - Christopher G. Hughes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin High
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janna S. Landsperger
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen E. Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michelle P. Howell
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Sarah W. Robison
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham
| | - John P. Gaillard
- Department of Emergency Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Micah R. Whitson
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham
- Department of Emergency Medicine, University of Alabama at Birmingham
| | | | | | | | - Bret D. Alvis
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Derek W. Russell
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham
- Pulmonary Section, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Kevin W. Gibbs
- Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - David R. Janz
- University Medical Center New Orleans, New Orleans, Louisiana
- Section of Pulmonary/Critical Care Medicine & Allergy/Immunology, Louisiana State University School of Medicine, New Orleans
| | - Todd W. Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew E. Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Jonathan D. Casey
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Hofmeyr R, Pereira AI, Zdravkovic I, Sorbello M. On strife, natural selection and success in airway management during the COVID-19 pandemic: Shifting from best guess to best practice. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 40:1-3. [PMID: 38620747 PMCID: PMC8480913 DOI: 10.1016/j.tacc.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Ross Hofmeyr
- Anaesthesia and Perioperative Medicine, University of Cape Town, And Groote Schuur Hospital, Cape Town, South Africa
| | - Ana Isabel Pereira
- Anaesthesia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ivana Zdravkovic
- Anaesthesia and Intensive Care, Casa di Cura Gibiino, Catania, Italy
| | - Massimiliano Sorbello
- Anaesthesia and Intensive Care, Policlinico San Marco University Hospital, Catania, Italy
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