Using a long semi-rigid catheter with a controllable tip to facilitate tracheal intubation with a GlideScope®

Abstract

To the Editor, The recently developed GlideScope (GS) (Original model, Verathon Inc., Bothel, WA, USA) has become very popular for managing both difficult and routine tracheal intubations. The GS allows improved visualization of the vocal cords, but occasionally inserting the endotracheal tube (ETT) may be difficult. In cases where the glottic opening is situated very anterior, the ETT tends to be directed into the larynx with an angle almost perpendicular to the axis of the trachea. This situation can lead to the failure of intubation. A number of solutions for this well-known problem have been suggested already, including the use of a preformed stylet or an Eschmann Tracheal Tube Introducer (gum elastic bougie), or possibly using a combination of a GlideScope and a fibreoptic bronchoscope (FOB) to facilitate intubation. This latter combination is especially beneficial when the GS view is suboptimal. We frequently use this technique, and in our view, the crucial factor for success is the FOB’s flexibility, which allows the ETT to pass easily through the glottis. In the majority of cases, the fibreoptic bronchoscope is not absolutely necessary and could be replaced by a catheter with a controllable tip. Unfortunately, this type of equipment is not freely available; therefore, we recommend using a special type of endobronchial blocker, namely, the Cook Cohen Tip Deflecting Endobronchial Blocker Set (Cook Critical Care, Bloomington, IN, USA). This device consists of a long semi-rigid catheter with a controllable distal tip that can be flexed by rotating a small steering wheel at the proximal end of the endobronchial blocker. This manipulation enables the catheter to be directed into the trachea in cases where the vocal cords are situated very anterior (Fig. 1). The ETT can then be passed easily over the catheter. One clinician can manage the tracheal intubation without additional help. We have successfully performed tracheal intubations on eleven patients using this procedure. To our knowledge, the endobronchial blocker set (Cook ) is the only device that has the ability to steer the tip of the catheter in different directions. This endobronchial blocker is relatively expensive, but a catheter with an adjustable tip may be considered a prototype. The development of a simple device with a controllable tip would be a useful adjunct for indirect laryngoscopic intubation techniques.