Comparison of the Shikani Optical Stylet and Macintosh Laryngoscope for Orotracheal Intubation with Topical Anesthesia in Critically Ill Patients

Zhipeng Li

doi:10.11648/j.cmr.20180704.11

Abstract

Background: Emergency airway management outside operating room (OR) is associated with a higher incidence of difficult intubations. The Shikani optical stylet (SOS) has been shown to improve first-attempt success rates compared with the classic Macintosh laryngoscope (ML) in patients with difficult airway inside the operating room (OR). Objective: In this randomized controlled clinical trial, the effectiveness of using a SOS as the primary intubation device was assessed during urgent endotracheal intubations (UEI) in conscious, critically ill patients outside the OR. Method: Sixty conscious critically ill patients from May 2018 to March 2018 were randomly assigned to undergoing intubation guided by the SOS (group S, n = 30) or the Macintosh laryngoscope (group M, n = 30) in ChanCheng Center Hospital,. After application of airway topical anesthesia and intravenous sedatives, endotracheal intubations were performed. The primary measured outcome was first-attempt intubation success rate. Secondary outcomes included ultimate success, the number of attempts, the duration of intubation, and the adverse effects or complications of intubation. Result: The rate of successful intubation at the first-attempt was superior with the SOS as compared with the ML (93.3% vs 63.3%, P = 0.005), the average number of attempts required for successful tracheal intubation (1.0 ± 0.3 vs 1.5 ± 0.8, P = 0.004), the duration of intubation (18.8 ± 11.9 vs 26.8 ± 15.6, P = 0.028), and the incidences of hemorrhage in the oropharyngeal mucosa (0 vs 28.6%, P = 0.006) were all improved significantly with use of the SOS compared with the ML. Conclusion: This study suggested SOS could be used as the effective device when UEIs are performed by experienced operators in conscious, critically ill patients outside the operating room.

Highlights

Hypoxemia due to airway obstruction or respiratory inhibition often threatens the lives of critically ill patients
One patient of them was intubated through the nose with the fiberbronchoscope, the other was successfully intubated with the Shikani optical stylet (SOS)
The present study demonstrated higher rate of first-attempt success of tracheal intubation, less time required for intubation and hemorrhage complications during urgent endotracheal intubations (UEI) when a SOS was used as the primary intubating device compared with a Macintosh laryngoscope (ML) in awake, critically ill patients

Summary

Introduction

Hypoxemia due to airway obstruction or respiratory inhibition often threatens the lives of critically ill patients. Emergency airway management in critically ill patients outside operating room (OR) is associated with a higher incidence of difficult intubations, ranging from 10% to 22%, and increases the risk of respiratory and hemodynamic complications, including death [3,4,5,6,7,8]. The usefulness of the SOS for urgent endotracheal intubations (UEIs) in Zhipeng Li et al.: Comparison of the Shikani Optical Stylet and Macintosh Laryngoscope for Orotracheal. Emergency airway management outside operating room (OR) is associated with a higher incidence of difficult intubations. The Shikani optical stylet (SOS) has been shown to improve first-attempt success rates compared with the classic Macintosh laryngoscope (ML) in patients with difficult airway inside the operating room (OR). Conclusion: This study suggested SOS could be used as the effective device when UEIs are performed by experienced operators in conscious, critically ill patients outside the operating room

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Discussion

Conclusion