Utility of a Modified Oropharyngeal Airway for Performing Tracheal Intubation Using a Fiberoptic Bronchoscope and Video Stylet: A Randomized Crossover Trial Using a Manikin.

Jang Hee Lee,Sang O Park,Ji Ung Na,Pil Cho Choi,Sang Kuk Han,Dong Hyuk Shin,Won Jae Kim,Chak W Kam

doi:10.1155/2020/3017297

Jang Hee Lee, Sang O Park + Show 6 more

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https://doi.org/10.1155/2020/3017297

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Abstract

Purpose The purpose of this study was to assess if a modified airway (MA), developed by the authors, would act as a guide and improve the performance of intubation when used with a video stylet (VS) or fiberoptic bronchoscope (FOB) for endotracheal intubation. Methods This randomized crossover simulation study using manikins was conducted with 36 novice operators. Time to complete intubation, time to see the glottis, and success rate of intubation of each device were measured and compared with or without use of MA. Results For intubation using FOB with MA, the median time to complete intubation significantly reduced from 46 to 31 seconds with a medium effect size (p=0.004, r = 0.483), and the median time to see the glottis significantly reduced from 7 to 5 seconds with a medium effect size (p=0.032, r = 0.357). The overall success rate was not statistically different between FOB with MA (33/36, 91.7%) and FOB alone (31/36, 86.1%); however, the cumulative success rate over time for FOB with MA was higher than that for FOB alone (p=0.333). For intubation using VS, there were no differences in the time to see the glottis and time to complete intubation between VS with MA and VS alone (p=0.065 and p=0.926, respectively), and the cumulative success rate was not statistically significant (p=0.594). Conclusion Adjunct use of MA helped reduce time to complete intubation in FOB, but not in VS. If an inexperienced operator uses FOB, it would be helpful to use MA as an adjunct device.

Highlights

Endotracheal intubation is the most important technique in emergency airway management
We aimed to determine whether our modified airway (MA) acts as a guide and improves the performance of intubation when used with video stylet (VS) or fiberoptic bronchoscope (FOB) for endotracheal intubation
When comparing VS alone and FOB alone, the median time to complete intubation was faster with VS alone (26.5 seconds) than with FOB alone (46.0 seconds) (p < 0.001), but the median time to see the glottis was not statistically different between VS alone (8 seconds) and FOB alone (7 seconds) (p 0.333). e cumulative success rate over time was higher for VS alone (35/36, 97.2%) than for FOB alone (31/36, 86.1%) (p < 0.001)

Summary

Introduction

Endotracheal intubation is the most important technique in emergency airway management. A video laryngoscope with a similar form of DL can gain visibility into glottis with the minimal use of the head tilt-chin lift maneuver and pressure applied to the vallecula; it may not be completely free from causing adverse hemodynamic effects [4–7]. Ese devices consist of a tube mounted on a video-embedded fiber or stylet and are inserted directly into the glottis; there is no need to align the oropharyngeal-laryngeal axis and apply pressure to the vallecula [8–10]. For those reasons, the Emergency Medicine International

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