Incidence Of Successful Intubation Research Articles

Laryngoscopy and Tracheal Intubation: Does Use of a Video Laryngoscope Facilitate Both Steps of the Procedure?

To compare the effect of the use of a video laryngoscope versus a direct laryngoscope on each step of emergency intubation: laryngoscopy (step 1) and intubation of the trachea (step 2). In a secondary observational analysis of data from 2 multicenter, randomized trials that enrolled critically ill adults undergoing tracheal intubation but did not control for laryngoscope type (video laryngoscope vs direct laryngoscope), we fit mixed-effects logistic regression models examining the 1) the association between laryngoscope type (video laryngoscope vs direct laryngoscope) and the Cormack-Lehane grade of view and 2) the interaction between grade of view, laryngoscope type (video laryngoscope vs direct laryngoscope), and the incidence of successful intubation on the first attempt. We analyzed 1,786 patients: 467 (26.2%) in the direct laryngoscope group and 1,319 (73.9%) in the video laryngoscope group. The use of a video laryngoscope was associated with an improved grade of view as compared with a direct laryngoscope (adjusted odds ratio for increasingly favorable grade of view 3.14, 95% confidence interval [CI] 2.47 to 3.99). Successful intubation on the first attempt occurred in 83.2% of patients in the video laryngoscope group and 72.2% of patients in the direct laryngoscope group (absolute difference 11.1%, 95% CI 6.5% to 15.6%). Video laryngoscope use modified the association between grade of view and successful intubation on the first attempt such that intubation on the first attempt was similar between video laryngoscope and direct laryngoscope at a grade 1 view and higher for video laryngoscope than direct laryngoscope at grade 2 to 4 views (P<.001 for interaction term). Among critically ill adults undergoing tracheal intubation, the use of a video laryngoscope was associated both with a better view of the vocal cords and with a higher probability of successfully intubating the trachea when the view of the vocal cords was incomplete in this observational analysis. However, a multicenter, randomized trial directly comparing the effect of a video laryngoscope with a direct laryngoscope on the grade of view, success, and complications is needed.

Intubation characteristics using modified USB videolaryngoscope: A prospective, randomised study.

Videolaryngoscopes with varying characteristics with regard to angulation of blades and video configurations are now available. However, the contribution of each of these in improving ease of intubation is quite different. We evaluated the role of video camera in the performance of laryngoscopy by using the universal serial bus (USB) videolaryngoscope in patients with predicted difficult airway. Sixty patients in the age group of 25 to 65 years having Mallampati grade III or IV were randomly allocated to two groups. All patients were American Society of Anesthesiologists physical status grade I or II and planned for elective surgical procedure under general anesthesia. USB videolaryngoscope or Macintosh laryngoscope was used for intubation as per group allotted. Comparison of time of endotracheal intubation was our primary outcome measure and it was calculated from the time the laryngoscope tip passes the incisors to the initial appearance of capnography wave. Rate of successful intubation, number of attempts needed for successful tube placement, optimisation manoeuvres used, changes in haemodynamic parameters and airway injuries were evaluated as secondary outcomes. Time for intubation was shorter in the Macintosh group than the USB group (P = 0.024). The incidence of successful intubation was similar in both groups (P = 0.079). USB group required lesser number of attempts for tube placement (P = 0.047). The incidence of airway injuries was similar in both the groups. USB videolaryngoscope reduces the number of attempts required for successful endotracheal intubation compared to Macintosh laryngoscope though it increases the time for intubation in patients with predicted difficult airway.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Effects of tip-manipulated stylet angle on intubation using the GlideScope® videolaryngoscope in children: A prospective randomized controlled trial.

An optimal endotracheal tube curve can be a key factor in successful intubation using the GlideScope videolaryngoscope. This study aimed to evaluate the effects of tube tip-modified stylet curve on the intubation time in children. Children aged 1-5years were randomly assigned to either the standard curve (group S, n=60) or tip-modified curve (group T, n=60) groups. In group S, the endotracheal tube curve was similar to that in the GlideScope. In group T, a point approximately 1.5cm from the tube tip was additionally angled to the left by 15°-20°. The primary outcome was the total intubation time, and the secondary outcomes were incidence of successful intubation in the first attempt, number of additional manipulations of the stylet curve, and visual analog scale (VAS) score for the easiness of intubation. The mean total intubation time was significantly longer in group S than that in group T (13.9 [10.8] vs. 9.0 [3.4] sec, mean difference, 4.9s; 95% confidence interval [CI], 2.0-7.8; p=.001). All patients in group T were successfully intubated in the first attempt, whereas those in group S were not (100% vs. 93.3%, relative risk [RR], 0.11; 95% CI, 0.01-2.02; p=.1376). Three patients in group S could be intubated after modifying the ETT curve similar to that in group T. Operators reported that tracheal intubation was easier in group T than in group S (median [interquartile range] for VAS; 1 [1-2] vs. 2 [1-3]; p<.001). Having additional angle of the endotracheal tube tip to the left could be a useful technique to facilitate directing and advancing endotracheal tube into the vocal cords.

A multicentre, randomised trial of stabilisation with nasal high flow during neonatal endotracheal intubation (the SHINE trial): a study protocol

IntroductionNeonatal endotracheal intubation is an essential but potentially destabilising procedure. With an increased focus on avoiding mechanical ventilation, particularly in preterm infants, there are fewer opportunities for clinicians to gain...

Comparison of endotracheal intubation time in neutral position between C-Mac® and Airtraq® laryngoscopes: A prospective randomised study.

Background and Aims:In the recent past, many novel devices such as AirTraq® and C-MAC® video laryngoscope (VL) have been introduced in an attempt to reduce anaesthetic morbidity and mortality associated with difficult intubation. In this study, we aimed to evaluate and compare C-MAC® VL with a standard Macintosh blade and the AirTraq® optical laryngoscope as a intubating devices with the patient's head in neutral position.Methods:Sixty American Society of Anesthesiologist Physical Status I–II patients were randomly assigned to be intubated with C-MAC® VL (Group CM; n = 30) or AirTraq® (Group AT; n = 30) in the neutral position, with or without the application of optimization manoeuvres. The primary outcomes of this study were the success rate and the time taken to intubate. Glottic view, ease of tracheal intubation and haemodynamic responses were considered as secondary end points.Results:The incidence of successful intubation was similar in both the groups (P = 1.00). However, the time for intubation was significantly less with C-MAC® VL (Group CM = 14.9 ± 12.89 s, Group AT = 26.3 ± 13.34 s; P = 0.0014). There was no significant difference between the two groups in terms of ease of intubation and glottic view. However, the haemodynamic perturbations were much less with C-MAC® VL.Conclusion:We conclude that both the devices were similar in visualising larynx in the neutral position with similar success rates of intubation. However, the C-MAC® VL was better with respect to intubation time and haemodynamic stability.

Observation of the efficacy of digital rectal enema on tumor patients with constipation during chemotherapy

Objective To explore the efficacy of digital rectal enema on tumor patients with constipation during chemotherapy .Methods Two hundred tumor patients with constipation during chemotherapy were divided into the control group and the experimental group according to stratified blocked randomization , each with 100 cases.The control group received the conventional enema , and the experimental group received the digital rectal enema .Results The incidence of successful intubation one time in the experimental group was 98.0%, and was higher than 85.0%in the control group , and the difference was statistically significant （χ2 =10.865,P〈0.01）.The incidence of adverse reactions in the process of intubation was 6% in the experimental group, and was lower than 17%in the control group, and the difference was statistically significant （χ2 =5.944, P〈0.05）.The incidence of severe pain in the experimental group was 5%, and was lower than 17% in the control group, and the difference was statistically significant （u=-3.505,P〈0.01）.Conclusions Compared with the conventional enema , the digital rectal enema is safer and more effective , and can reduce the patient ’ s suffering, and bears a great value in clinical practice . Key words: Tumor; Constipation; Enema; Finger probe; During chemotherapy

Evaluation of three adjusting manoeuvres and type of endotracheal tube in the success of air-Q™ aided tracheal intubation

Background: The present study observed whether the use of three different adjusting manoeuvres and use of an armoured tracheal tube would increase the success rate of tracheal intubation, aided by the air-Q™ intubating laryngeal airway (air-Q ™ ILA). Method: Fifty American Society of Anesthesiologists (ASA) I and II patients undergoing elective surgical procedures were randomly assigned to two groups. In the endotracheal tube (ETT) group, standard ETT was used, while in the armoured ETT (AETT) group, tracheal intubation was performed using AETT. After a uniform premedication, induction and relaxation technique, an appropriate sized air-Q ™ ILA with ETT in-situ, was placed. After good ventilation, a flexible fibrescope was passed down the ETT, and the percentage of glottic opening (POGO) was documented. Subsequently, three adjusting manoeuvres were applied in sequence. These included firstly, backward pressure over the larynx; secondly, head extension; and lastly, neck flexion. After noting the POGO score with each adjusting manoeuvre, the incidence of successful intubation was noted, with and without manoeuvres. Results: The best POGO score (84%) was observed with the application of backward pressure. Successful tracheal intubation was achieved in 56-60% of patients without the use of any manoeuvres, using either type of tracheal tube. For the rest, tracheal intubation was achieved using backward pressure, except in one patient from the ETT group. The incidence of successful tracheal intubation was nearly identical with either type of ETT. Conclusion: Successful tracheal intubation can be achieved in 96% of cases using adjusting manoeuvres. The nature of the tracheal tubes did not influence the success rate.

The Parker Flex-Tip™ tracheal tube makes endotracheal intubation with the Bullard laryngoscope easier and faster

The Bullard laryngoscope can be useful in management of difficult airway. When the endotracheal tube is advanced over the original Bullard laryngoscope stylet, the endotracheal tube sometimes makes contact with structures around the vocal cords, especially the right arytenoids. A similar problem also occurs with flexible fibreoptic intubation and it has been shown that use of the Parker Flex-Tip tube usually resolves the problem. In this study we tested our hypothesis that use of the Parker Flex-Tip tube might improve endotracheal tube passage with the Bullard laryngoscope. Forty patients scheduled for elective anaesthesia were randomly assigned into group ST (standard tube) or Group PT (Parker Flex-Tip tube). The time taken to achieve successful endotracheal tube placement after obtaining the best laryngeal view, the number of attempts at intubation and the incidences of successful intubation at first attempt and of re-direction of the Bullard laryngoscope during intubation were recorded. Unpaired t-test and chi2-test were employed and P < 0.05 was considered significant. Use of the Parker Flex-Tip tube reduced the time required for successful endotracheal tube placement after the best laryngeal view was obtained from 14 +/- 6 to 6 +/- 2 s (P < 0.01). It also reduced the incidence of requirement for re-direction of the Bullard laryngoscope during intubation from 10/19 to 1/19 (P < 0.01). The incidence of successful intubation at the first attempt (18/19 vs. 15/19) was higher in the PT group but the difference was not statistically significant. During intubation with the Bullard laryngoscope, use of the Parker Flex-Tip tube is associated with more rapid success and a lower incidence of re-direction of the Bullard laryngoscope during endotracheal intubation when compared to a standard endotracheal tube.