Success Rate Of Intubation Research Articles

Comparative evaluation of first-attempt intubation success rate using direct laryngoscope with Macintosh blade and video laryngoscope during rapid sequence induction in patients undergoing emergency surgery: A prospective randomised controlled trial.

Airway management skills form the cornerstone of routine anaesthesia practice. Its role becomes more significant in emergency areas where time is of the essence. Patients presenting for emergency surgery require definitive airway management with endotracheal intubation. Rapid sequence induction with direct laryngoscopy using a Macintosh blade has been used consistently with varying success. With the advent of video laryngoscopes, their utility is being explored in emergency areas. We aimed to assess the role of a video laryngoscope (Medizintechnik, Sulz, Germany) in rapid sequence induction and intubation during emergency surgeries. We hypothesised that video laryngoscope would improve the first-attempt intubation success rate in patients undergoing emergency surgery. In total, 76 patients presenting for emergency surgery were enrolled and randomly assigned into two groups (38 each), who were intubated with either a video laryngoscope or Macintosh blade during rapid sequence induction. This study aimed to compare and evaluate direct laryngoscopy using a Macintosh blade and a video laryngoscope during rapid sequence induction. The two groups were similar in the type and indication for surgery. Airway characteristics were also compared, and there were no significant differences in all airway parameters, including mouth opening, thyromental distance, Mallampati grading and neck circumference. The first-attempt intubation success rate was significantly higher in the video laryngoscope group (p = 0.017, χ2 = 5.684). The Cormack-Lehane grade distribution was compared in both groups, with better glottis visualisation in group video laryngoscope (p = 0.028, χ2 = 9.123). This prospective, randomised, controlled study aimed to compare the first-attempt intubation success rate using direct laryngoscopy with a Macintosh blade and a video laryngoscope during rapid sequence induction in patients undergoing emergency surgeries and observed that first-attempt intubation success rate was significantly higher in group video laryngoscope (86.8%) than in group direct laryngoscopy (63.2%). Therefore, video laryngoscopy offers an attractive alternative to conventional laryngoscopy while securing the airway in patients presenting for emergency surgery.

A visual laryngoscope combined with a fiberoptic bronchoscope improves intubation outcomes in patients with predicted difficult airways in thoracic surgery

ObjectiveTo study the clinical effectiveness of visual laryngoscopy combined with fiberoptic bronchoscopy-guided double-lumen endotracheal tube intubation in thoracic surgery patients with predicted difficult airways in thoracic surgery airways.MethodsWe randomly divided 162 patients with predicted difficult airways who required double-lumen tracheal intubation for thoracic surgery and randomly divided them into the video laryngoscopy group (Group VL, n = 54),fiberoptic bronchoscopy group (Group F, n = 54), and video laryngoscopy combined with fiberoptic bronchoscopy group (Group FVL, n = 54) according to the randomized number table method. Then, the success rate of the first intubation, the duration of intubation, the duration of positioning, the degree of exposure of the vocal cords (Cormack-Lehane grade), and the adverse reactions during intubation were recorded and analyzed.ResultsThe success rate of first-time intubation was significantly higher in the FVL group than in the F and VL groups (92.6% vs. 87.0% vs. 53.7%, P < 0.001), and the time of intubation in the FVL group was significantly shorter than that in the VL and F groups [(26.22 ± 9.34) s vs. (42.35 ± 11.21) s vs. (46.78 ± 21.96) s, P < 0.001)]. The positioning time in the FVL group was significantly shorter than that in the F and VL groups [(83.76 ± 15.18) s vs. (102.72 ± 21.89) s vs. (145.41 ± 20.12) s, F = 144.896, P < 0.001)].The number of patients with Cormack-Lehane grades I-II was significantly lower in the FVL group and the VL group than in the F group (88.9% vs. 77.8% vs. 59.3%, P < 0.05).The incidence of postoperative sore throat was significantly lower in the FVL group and the F group than in the VL group (22.4% vs. 27.6% vs. 50%, P < 0.001).ConclusionIn difficult airway patients with high airway risk indices who require double-lumen endotracheal intubation, visual laryngoscopy combined with fiberoptic bronchoscopy improved the success rate of first-time intubation and shortened the intubation and positioning time.Trial registrationChinese Clinical Trial Register (identifier: ChiCTR2300076304; Date of registration: September 29, 2023).

Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrathTM video laryngoscope: a prospective randomized trial.

Airway management in children is challenging because of the smaller size, different proportions of anatomical structures compared to adults, and a higher risk of hypoxemia. Efforts to improve the efficiency of pediatric intubation can be made by manually twisting a spiral endotracheal tube (ETT) using a flexible stylet to manipulate its shape and angle. This controlled trial randomized fifty children aged one month to six years who underwent elective surgery under general anesthesia into two groups (spiral ETT [sETT] and no-stylet ETT/standard ETT). The sETT was formed by twisting the ETT using a handmade tool. The primary objective was to determine the effectiveness of the sETT compared to the standard ETT in reducing intubation time. Secondary objectives were ETT placement accuracy, first-attempt intubation success rate, and adverse effects. The mean total tube handling time in the sETT group was significantly shorter compared to the no-stylet ETT group (sETT 16.8 ± 3.6 vs. standard ETT 18.8 ± 3.7 seconds; P = 0.049). sETT placement had a significantly greater central placement accuracy (odds ratio, 4.846; 95% confidence interval, 1.287-18.255; P = 0.015). However, first-attempt successful intubation rate (sETT 80% vs. standard ETT 64%, P = 0.208) and total intubation time (sETT: 46.5 ± 5.2 vs. standard ETT 48.4 ± 4.9 seconds; P = 0.205) were not significantly different. No adverse effects were observed for either ETT type. Spiral ETT effectively reduces total tube handling time and improves ETT placement accuracy in children using video laryngoscopy.

Sedation for awake tracheal intubation: A systematic review and network meta-analysis.

Different sedation regimens have been used to facilitate awake tracheal intubation, but the evidence has not been synthesised robustly, particularly with respect to clinically important outcomes. We conducted a systematic review and network meta-analysis to determine the sedation techniques most likely to be associated with successful tracheal intubation, a shorter time to successful intubation and a lower risk of arterial oxygen desaturation. We searched for randomised controlled trials of patients undergoing awake tracheal intubation for any indication and reporting: overall tracheal intubation success rate; tracheal intubation time; incidence of arterial oxygen desaturation; and other related outcomes. We performed a frequentist network meta-analysis for these outcomes if two or more sedation regimens were compared between included trials. We also performed a sensitivity analysis excluding trials with a high risk of bias. In total, 48 studies with 2837 patients comparing 33 different regimens were included. Comparing overall awake tracheal intubation success rates (38 studies, 2139 patients), there was no evidence suggesting that any individual sedation regimen was superior. Comparing times to successful tracheal intubation (1745 patients, 24 studies), any sedation strategy was superior to placebo. When we excluded trials with a high risk of bias, we found no evidence of a difference between any interventions for time to successful tracheal intubation. Thirty-one studies (1753 patients) suggested that dexmedetomidine and magnesium sulphate were associated with a reduced risk of arterial oxygen desaturation compared with other interventions, but excluding trials with a high risk of bias suggested no relevant differences between interventions. The quality of evidence for each of our outcomes was low. To maximise effective and safe awake tracheal intubation, optimising oxygenation, topical airway anaesthesia and procedural performance may have more impact than any given sedation regimen.

Comparison of Drug-Assisted Tracheal Intubation Using Benzodiazepines and Induction Agents for First-Pass Intubation Success in Emergency Airway Management: A Retrospective Cohort Study

Objective: To determine first-pass intubation success between benzodiazepines and induction agents in adult patients who underwent drug-assisted intubation in the emergency department (ED). Materials and Methods: A retrospective chart review observational study collected the data of patients who underwent drug-assisted intubation in the ED of a university teaching hospital between January 1, 2021 and August 31, 2022. Two hundred seven patients were enrolled in the present study. The benzodiazepine and induction agent groups were compared in terms of baseline characteristics, and clinical management. Each benzodiazepine and induction agent were compared in first-pass intubation success, time to intubation success, adverse events, and 24-hour mortality. Results: Of the 207 patients included in the present study, 35 patients used benzodiazepine, and 172 patients used induction agents. The two groups had no differences in baseline characteristics. The first-pass intubation success rate was not significantly different among the medications with 90% in nine diazepam patients, 92% in 23 midazolam patients, 89.8% in 79 etomidate patients, and 94% in 79 propofol patients (p=0.553). Complications associated with intubation included hypotension, desaturation, tachycardia, bradycardia, arrhythmia, cardiac arrest, and pneumonia. No differences in 24-hour survival were observed. Conclusion: The sedative medications used during drug-assisted intubation should be chosen based on patient comorbidities and characteristics, as well as physician preferences and experiences. There were no differences between the benzodiazepine and induction agent groups in terms of first-pass intubation success, adverse events, or 24-hour survival. The use of benzodiazepines in settings with limited resources may be considered.

Visual rigid laryngoscopy versus video laryngoscopy for endotracheal intubation in elderly patients: A randomized controlled trial.

To assess the efficacy and safety of visual rigid laryngoscopy and video laryngoscopy and to provide clinical information for developing a more suitable intubation tool for elderly patients. In 75 consecutive elderly patients undergoing elective surgery in a single institution, tracheal intubation was randomly performed by 2 experienced anaesthesiologists using visual rigid laryngoscopy (Group I, n = 38) or video laryngoscopy (Group II, n = 37). The primary outcome was intubation time. Secondary outcomes were the first-attempt success rate of tracheal intubation, haemodynamic responses at 1, 3, and 5 min after intubation and the incidence of postoperative airway complications, including immediate complications and postoperative complaints. The intubation times were 35.0 (30.0-41.5) s and 42.5 (38.0-51.3) s in Groups I and II, respectively (P < 0.001). The difference in direct complications between the two groups was statistically significant (P < 0.05). In contrast, there was no significant difference between the two groups regarding the follow-up of the main complaint 30 min and 24 h after tracheal extubation (P > 0.05). There was no difference in the intubation success rate between the 2 groups (P > 0.05). The haemodynamic responses at 1, 3, and 5 min after intubation were not significantly different (P > 0.05). Compared with that of video laryngoscopy, the intubation time of visual rigid laryngoscopy in elderly patients was shorter. At the same time, visual rigid laryngoscopy reduced the incidence of immediate complications. However, during endotracheal intubation, there was no significant difference in haemodynamics between the two groups. ChiCTR2100054174.

Video laryngoscopy may improve the intubation outcomes in critically ill patients: a systematic review and meta-analysis of randomised controlled trials

BackgroundThe role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical...

Comparison of Tracheal Intubation Using the Air-Q ILA and LMA Blockbuster Among Adults Undergoing Elective Surgery: A Randomized Controlled Trial.

Air-Q intubating laryngeal airway (ILA) is associated with a 58-77% success rate in blind intubation. The newer laryngeal mask airway (LMA) blockbuster is specially designed to facilitate easier endotracheal intubation and may have a higher success rate. The current study aimed to compare the success rate of endotracheal intubation using the Air-Q ILA and LMA blockbuster. After ethics committee approval and informed written consent, 140 adult patients with normal airways who were scheduled for elective surgery under general anaesthesia requiring endotracheal intubation were recruited for this randomized controlled trial. Blind endotracheal intubation was performed using the Air-Q ILA in group A and the LMA blockbuster in group B with special maneuvers and/or tubes in the second attempt. Fibreoptic bronchoscope (FOB) guidance was used in the third attempt if required. The primary outcome was the success rate of intubation without FOB assistance. The number of attempts for supraglottic airway (SGA) insertion, the time taken for SGA insertion, and the overall intubation time was also noted. The success rate of intubation without FOB guidance was significantly higher in group B than in group A [91.4% vs 55.7%; relative risk (RR) 1.68; (95% confidence interval (CI) 1.34, 2.11); p<0.0001]. The number of attempts for SGA insertion was similar in groups A and group B [87% vs 90%; RR 1.03; (95% CI-0.92, 1.16); p=0.60]. The times for successful SGA insertion and endotracheal intubation were also similar between the groups. The LMA blockbuster offers a significantly higher success rate for endotracheal intubation without FOB guidance than the Air-Q ILA in adult patients with normal airways. However, an increased success rate was achieved with the use of a specially designed flexible endotracheal tube and maneuvers.

Comparison of Three Tracheal Intubation Procedures Using Personal Protective Equipment, Direct and Video Laryngoscopes: An Open, Randomized, Parallel Clinical Trial

Background: During the COVID-19 pandemic, severe respiratory failure is a life-threatening condition, and life-saving tracheal intubation is a high-risk aerosol- and droplet-generating procedure. It is crucial to protect healthcare workers without compromising patient safety during intubation. The use of personal protective equipment (PPE) and different types of laryngoscopes are measures to reduce the risk of infectious transmission that might impact the intubation process. Objectives: This study aimed to evaluate the effects of different levels of PPE and types of laryngoscopes on the duration of the intubation process and its success rate. Methods: We conducted an open, randomized, parallel clinical trial on non-COVID-19 adult patients scheduled for elective and emergency surgeries under general anesthesia from November 2021 to May 2022. Patients were divided into three groups: Group 1 was intubated using a video-guided laryngoscope with operators wearing level three PPE; group 2 was intubated using a direct laryngoscope with operators wearing level three PPE; and group 3 was intubated using a direct laryngoscope with operators wearing level two PPE. Intubation was performed by 2nd- and 3rd-year anesthesia residents. Results: The duration of intubation varied significantly among the groups, with Group 1 taking the longest time (P = 0.046). Group 3 had a higher success rate for first-attempt intubation (P = 0.056). Conclusions: The use of PPE and video-guided laryngoscopy had varying effects on the intubation procedure, with the most notable impact being on the overall length of intubation. Further research with a larger sample size is needed to validate these findings.

Comparison of Clinical Performance of I-gel and Fastrach Laryngeal Mask Airway as an Intubating Device in Adults: A Systematic Review and Meta-Analysis.

The supraglottic airway device (SGD) was introduced as a breakthrough in airway management. The Fastrach emerged as the first commercially available intubating SGD, drawing extensive investigation. I-gel is a more recent device that has gained popularity, can be used as an intubating SGD, and replaced Fastrach in many institutions. However, there is uncertainty regarding the comparison between these devices in terms of efficacy for intubation and ventilation, and safety in an airway rescue situation. PubMed, EMBASE, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing I-gel and Fastrach SGD in adult patients undergoing intubation. The primary outcome was the first-pass success rate for tracheal intubation. Secondary outcomes were tracheal intubation time, SGD insertion time and success, and complications. We computed risk ratios (RRs) to assess binary end points and weighted mean differences (WMDs) for continuous outcomes, with corresponding 95% confidence intervals (CIs) for the primary outcome and its subgroup analysis (P < .05 was considered statistically significant) and 99% CI after Bonferroni correction for the secondary outcomes (P < .01 was considered statistically significant). This study included a total of 14 RCTs encompassing 1340 patients. The results indicated a significant difference in the first-pass success rate favoring Fastrach (RR, 0.81; 95% CI, 0.67-0.98; P = .03; I² = 91%). In the subgroup analysis, when a flexible scope was utilized through I-gel, providers achieved a better tracheal intubation first-pass success rate (RR, 1.05; 95% CI, 1.01-1.11; P = .03; I² = 0%), compared with the Fastrach. Overall intubation success rates (RR, 0.92; 99% CI, 0.82-1.04; P = .08, I² = 92%) and time (WMD - 1.03 seconds; 99% CI, -4.75 to 2.69; P = .48; I² = 84%) showed no significant difference irrespective of the device used. There was no significant difference regarding device insertion time by the providers (WMD -6.48 seconds; 99% CI, -13.23 to 0.27; P = .01; I2 = 98%). Success rates of the providers' initial SGD insertion and complications such as sore throat (RR, 1.01; 99% CI, 0.65-1.57; P = .95, I² = 33%) and blood presence post-SGD removal (RR, 0.89; 99% CI, 0.42-1.86; P = .68, I² = 0%) showed no significant difference. Based on our findings, a higher first-pass success rate was observed with the use of Fastrach when compared to I-gel. However, the use of I-gel might result in a better intubation success rate with the flexible scope-guided intubation. There are no significant differences in performance in terms of the success rate for intubation overall, time for device insertion, or time to intubation or complications regardless of the device used.

Quality and safety in prehospital airway management – retrospective analysis of 18,000 cases from an air rescue database in Germany

BackgroundPrehospital airway management remains crucial with regard to the quality and safety of emergency medical service (EMS) systems worldwide. In 2007, the benchmark study by Timmermann et al. hit the German EMS community hard by revealing a significant rate of undetected oesophageal intubations leading to an often-fatal outcome. Since then, much attention has been given to guideline development and training. This study evaluated the incidence and special circumstances of tube misplacement as an adverse peri-intubation event from a Helicopter Emergency Medical Services perspective.MethodsThis was a retrospective analysis of a German helicopter-based EMS database from January 1, 2012, to December 31, 2020. All registered patients were included in the primary analysis. The results were analysed using SPSS 27.0.1.0.ResultsOut of 227,459 emergency medical responses overall, a total of 18,087 (8.0%) involved invasive airway management. In 8141 (45.0%) of these patients, airway management devices were used by ground-based EMS staff, with an intubation rate of 96.6% (n = 7861), and alternative airways were used in 3.2% (n = 285). Overall, the rate of endotracheal intubation success was 94.7%, while adverse events in the form of tube misplacement were present in 5.3%, with a 1.2% rate of undetected oesophageal intubation. Overall tube misplacement and undetected oesophageal intubation occurred more often after intubation was carried out by paramedics (10.4% and 3.6%, respectively). In view of special circumstances, those errors occurred more often in the presence of trauma or cardiopulmonary resuscitation, with rates of 5.6% and 6.4%, respectively. Difficult airways with a Cormack 4 status were present in 2.1% (n = 213) of HEMS patients, accompanied by three or more intubation attempts in 5.2% (n = 11).ConclusionsPrehospital airway management success has improved significantly in recent years. However, adverse peri-intubation events such as undetected oesophageal intubation remain a persistent threat to patient safety.Trial registrationThe study was registered in the German Register for Clinical Studies (number DRKS00028068).

Comparing Air Medical Personnel Intubation Success Rates Using Direct, Channeled Video-Assisted, and Unchanneled Video-Assisted Laryngoscopy

ObjectiveThe aim of this study was to determine the first-pass intubation success rates of air medical providers using direct laryngoscopy, channeled blade video laryngoscopy, and nonchanneled blade video laryngoscopy. MethodsThis was a retrospective cohort study of the Orlando Health Air Care Team (ACT) airway quality registry over a 5-year period. The ACT had 3 approved approaches for endotracheal intubation: direct laryngoscopy, the King Vision (Ambu, Ballerup Denmark) channeled blade laryngoscope, or the C-MAC (Karl-Storz, Tuttlingen Germany) (nonchanneled) laryngoscope. The main outcome was the first-pass success rate. The secondary outcomes included the number of attempts, the overall success rate, and complications. ResultsOf 517 intubations, 312 were performed with direct laryngoscopy, 126 with a channeled video laryngoscope, and 79 with a nonchanneled laryngoscope. The mean number of attempts was 1.26, and the overall success rate was 93%. Use of the nonchanneled video laryngoscope had a higher first-pass success rate than direct or channeled laryngoscopy (92% vs. 76% and 78%, P = .006), required fewer attempts (1.09 [95% confidence interval (CI), 1.01-1.17] vs. 1.29 [95% CI, 1.23-1.35] and 1.28 [95% CI, 1.18-1.38], P < .001), and a higher overall success rate for intubation (99% vs. 90% and 95%, P = .018). ConclusionThe use of a nonchanneled video laryngoscope provided higher first-pass success rates, fewer total attempts, and higher overall success rates.

Comparison of AirAngel® vs. Storz® videolaryngoscope and Macintosh® laryngoscope for endotracheal intubation training: prospective randomized crossover study

BackgroundFor both normal and difficult airway management, VL is thought to be more effective. However, VL seems far from being offered as a standard option in both healthcare delivery and educational activities in low-income countries, considering its high costs. Therefore, three-dimensional(3D)printed VLs may be considered an alternative to conventional VLs in low-income countries and other places with limited resources. Our objective was to compare the efficacy of AirAngel 3D-printed VL (3D-PVL) with those of commercially available Storz® VL (SVL) and conventional Macintosh® laryngoscope (MCL) in normal and difficult airway scenarios in the hands of inexperienced users.MethodsThis is a prospective randomized crossover manikin study that included 126 senior medical students with no experience in intubation. The effectiveness of all three laryngoscopy devices in the hands of inexperienced users was evaluated in terms of intubation time, glottic visualization, ease of use, endotracheal tube placement, and intubation success rate. Between 2020 and 2022, 126 last year medical students participated in the study.ResultsMCL resulted in significantly longer intubation times than 3D-PVL and SVL in the difficult airway scenario, with no significant difference between 3DPVL and SVL (Wilcoxon test, p < 0.016; Bonferroni correction MCL: 28.54 s; SVL: 26.68 s; 3DPVL: 26.64 s). Both SVL and 3D-PVL resulted in significantly better Cormack − Lehane grades in both normal and difficult airway scenarios, and thus provided better glottic viewing than MCL, with no significant difference between 3D-PVL and SVL (Wilcoxon test, p < 0.016; Bonferroni correction, MCL: 1.73; SVL: 1.29; 3DPVL: 1.25). The SVL was the easiest device to use for normal airway scenarios (1: very easy, 5: very difficult), while the MCL was the most difficult (MCL: 2.64; 3DPVL: 1.98; SVL: 1.49). Conversely, no significant difference was found between 3DPVL and other devices in terms of ease of use in difficult airway scenarios and in terms of accurate placement of the endotracheal tube and successful intubation attempts.Conclusion3D-PVL is a good educational and possible clinical alternative to conventional VL, particularly in places with limited resources, due to its low cost.

A Comparative Study Between Video Laryngoscope and Video Stylet for Tracheal Intubation in Patients With Simulated Cervical Fracture Injury: A Prospective Randomised Controlled Study.

Purpose Video laryngoscopes were being used more often in cases of potentially difficult airways. The Karl Storz video stylet offered clear advantages over conventional laryngoscopes for patients with cervical spine fractures. This study aimed to compare the performance of the C-MAC video laryngoscope with the new Karl Storz video stylet in patients with simulated cervical fracture injuries. Material and methods The study, approved by the Board of Studies and the Ethical Committee of Jawaharlal Nehru Medical College and Hospital in Aligarh, involved 50 patients undergoing operative procedures under general anaesthesia. It was a prospective randomised controlled study on patients aged 20-60, weighing 30-80 kg, and classified as American Society of Anesthesiologists (ASA) Grades I and II, admitted for elective operative procedures. Patients were randomly assigned to two groups for intubation using different devices: the control group (N = 25) was intubated with the C-MAC (Mac blade) video laryngoscope (CM), and the study group (N = 25) was intubated with the Karl Storz video stylet (VS). The anaesthetic procedure involved a detailed pre-anesthetic check-up for all patients, including a medical history review, physical examination, and necessary tests based on age. Standard monitoring and pre-medication were administered uniformly. Anesthesia was induced and intubation was attempted using appropriate devices, following manual stabilisation of the neck. Parameters such as intubation attempts, time taken, failures, hemodynamic changes, and complications were recorded throughout the procedure. If intubation was unsuccessful, alternative measures were taken, and the operative procedure proceeded. Results The intubation success rates were compared between the two groups, CM and VS. In the CM group, all 25 patients (100%) were successfully intubated on the first attempt, while in the VS group, 23 patients (92%) were successfully intubated on the first attempt, and two patients (8%) required two attempts. The difference in the distribution of the number of attempts between the two groups was not statistically significant (p = 0.4915). The mean intubation time in the CM group was 27.24 ± 2.16 seconds, while in the VS group, the mean intubation time was significantly longer at 30.84 ± 6.81 seconds, with a statistically significant difference (p = 0.0105). Adjustment manoeuvres were required in only 4% of patients in the CM group compared to 0% in the VS group, although this difference was not statistically significant. The occurrence of blood on the device during intubation was recorded, and the distribution of patients with blood on the device among the two groups did not show a statistically significant difference (p = 0.617). Conclusion This study compared the effectiveness of two intubation devices. The C-MAC video laryngoscope showed a significantly higher rate of first-attempt successful intubations and required fewer attempts compared to the Karl Storz video stylet. The C-MAC also had shorter intubation times compared to the Karl Storz device. However, the Karl Storz video stylet demonstrated comparable performance to the C-MAC video laryngoscope in clinical settings, with both devices having similar safety profiles and minimal complications.

Effectiveness of Airway Management Strategies in Critically Ill Patients: A Meta-Analysis

Background: Airway management is a cornerstone of critical care, but the optimal strategies for critically ill patients remain debated. This meta-analysis aimed to evaluate the effectiveness of various airway management techniques in critically ill patients. Methods: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted from January 2018 to December 2023. Studies comparing different airway management strategies (e.g., endotracheal intubation, laryngeal mask airway, video laryngoscopy) in critically ill adults were included. Primary outcomes were successful airway establishment, time to airway securement, and complications (e.g., hypoxia, aspiration). Meta-analyses were performed using random-effects models, and the risk of bias was assessed. Results: Twenty-three studies (n=5,894 patients) were included. Video laryngoscopy was associated with a higher success rate of first-pass intubation compared to direct laryngoscopy (OR 1.85, 95% CI 1.43-2.40, p&lt;0.001). No significant differences were found in overall complications between video laryngoscopy and direct laryngoscopy (OR 0.92, 95% CI 0.68-1.24, p=0.59). In patients with difficult airways, video laryngoscopy demonstrated a reduced risk of complications compared to direct laryngoscopy (OR 0.63, 95% CI 0.41-0.97, p=0.04). Conclusion: Video laryngoscopy is a safe and effective alternative to direct laryngoscopy, particularly in critically ill patients with predicted difficult airways. Further research is needed to determine the optimal airway management strategy in specific subgroups of critically ill patients.

A comparative study of head-elevated positions at 25° versus 45° for intubation in obese patients posted for elective surgery under general anesthesia

Background: Obese patients generally present with an increased risk of difficult intubation. The head-elevated position has been shown to improve laryngeal view, reduce airway complications, and prolong safe apnea time during intubation as compared to the sniffing position. Aims and Objectives: The aim of this study is to compare the head-elevated positions at 25° versus 45° for intubation in obese patients, in terms of ease of intubation assessed by first-attempt intubation success rate and laryngeal exposure using Cormack–Lehane grading and to assess intubation time, use of intubation aides, changes in hemodynamic parameters, and hypoxia. Materials and Methods: In this randomized controlled trial, 100 consenting patients undergoing elective surgery requiring general anesthesia were selected who fulfilled the eligibility criteria and assigned to either of the two groups by block randomization: Group A – 25° or Group B – 45° head-elevated positions for intubation in a tertiary care hospital (February 2021–July 2022). Results: The 45° head-elevated position was found to provide a better laryngeal exposure, the mean time to intubate was lesser and the first attempt success rate was also higher. Further, 45° head-elevated position is better chosen as per anesthesiologist comfort, using Likert scale grading. Conclusion: This study concluded that 45° head-elevated position provides better ease of intubation in obese patients as compared to 25° head-elevation.

Comparison of different head positions for ease of intubation in obese patients using videolaryngoscopy

BackgroundIn direct laryngoscopy ramping is a recommended technique in obese patients to improve success of intubation. Recently 25° back up position has also been described for the same purpose. The effect of change in head neck positions have not been much studied in obese patients, while using videolaryngoscopy (VL). MethodsThis prospective randomized study included 150 adult obese surgical patients (BMI >30 kg/m2), requiring intubation using VL. Patients were randomly assigned one of the three groups: sniffing position, ramped up position and 25° back up position. The time taken for intubation was the primary outcome. Other parameters assessed were Cormack-Lehane grading, time to achieve best glottic view, ease and attempts required for intubation. ResultsThe study shows that, 25° back up position has reduced time taken for successful intubation 161.80 s as compared to ramped up position (172.56 s) and sniffing position (171.84 s) with p value of <0.0001. Mean time for best glottic view was 18.82 s in group C, compared to 38.24 s for group B, and 39.66 s in group A (p < 0.0001). The ease of intubation score was also very easy/easy in 9/28 patients in group C compared to 3/16 and 3/17 patients respectively in groups A and B (p = 0.007). First attempt at intubation was successful in 47 patients in group C compared to 32 and 40 patients in groups A and B respectively (p = 0.001). There was no significant difference in Cormack and Lehane grading in different positions. ConclusionsThe 25° back up position is a simple and useful technique in improving glottic view and intubation success rate with reduction in intubation time compared to ramped up and sniffing positions.

Continuous Positive-Pressure Oxygen Supply Improves Fiberoptic Intubation Efficacy and Safety in Patients With Simulated Cervical Spinal Injury: A Prospective Double-Blind Randomized Controlled Study.

Fiberoptic intubation is an important method for tracheal intubation in patients with cervical spine injury. How to effectively and safely complete fiberoptic intubation while maintaining the stability of the cervical spine is very important. This study compared the efficiency and safety of fiberoptic intubation after anesthesia induction under different types of air pressure in patients with simulated cervical spinal injury. In total, 59 adult patients who underwent fiberoptic intubation with a cervical collar for simulated cervical spinal injury were randomly allocated to continuous positive-pressure oxygen, normal-pressure, or intermittent negative-pressure suction groups. After the induction of anesthesia and adequate 100% oxygenation, which confirmed effective neuromuscular blockade, it was deemed appropriate to begin fiberoptic intubation. In the continuous positive-pressure oxygen group, the fiberoptic device was connected through the negative-pressure suction path with 5 L/min oxygen. In the intermittent negative-pressure suction group, the fiberoptic device was connected to the negative-pressure suction device. In the normal-pressure group, the flexible fiberoptic device was not connected to either the oxygen source or the negative-pressure suction device. The intubation time was recorded as the primary outcome measure. The intubation success rate, number of attempts, minimum SpO2, objective lens contamination rate, and incidence of complications were also compared among the groups. Compared with those in the other groups, the median (range) intubation time in the continuous positive-pressure group was 59 (36-181) seconds, which was significantly shorter than that in the normal-pressure group, 167 (46-181) seconds, and the intermittent negative-pressure suction group, 132.5 (38-181) seconds (P=0.04). The success rate of nasotracheal intubation was significantly greater in the continuous positive-pressure group (94.7%, 18/19) than in the normal-pressure group (50%, 10/20) and intermittent negative-pressure suction group (50%, 10/20) (P=0.004). There was a significant difference among the three groups (P=0.043). The median (range) minimum SpO2 during fiberoptic intubation was 100% (99-100%) in the continuous positive-pressure group, 100% (90-100%) in the normal-pressure group, and 99% (88-100%) in the intermittent negative-pressure suction group (P=0.029). However, no statistically significant difference was detected among the groups with complications. The continuous use of positive-pressure oxygen via the negative-pressure suction pathway can improve the efficiency and safety of fiberoptic intubation in patients with simulated cervical spinal injury after anesthesia induction.

Probing and nasolacrimal intubation outcomes in children over 18 Months of age with congenital nasolacrimal duct obstruction

PurposeTo evaluate how risk factors impact success rates of initial probing and nasolacrimal duct (NLD) tube intubation in children over 18 months of age with congenital nasolacrimal duct obstruction (CNLDO). MethodsThis cohort study included 98 CNLDO patients aged 18 months to 10 years who underwent NLD probing with stent insertion. We employed the multivariate frailty model as our final model to conceptually elaborate on our correlated eye data, with the primary outcome measure evaluating the success rates of probing and tube intubation. Factors such as age, probing complexity, tube type, prior surgeries, and passive smoking were considered in the evaluation. ResultsThe study involved 98 patients (54 males, 44 females) with a mean age of 41.46 months and an average follow-up of 98.37 days (95 % CI 87.65–109.1). Out of the 110 eyes that underwent surgery, 13 (11.8 %) experienced failure while 97 (88.2 %) were censored. Kaplan-Meier analysis indicated significant differences in age category and probing (P-value = 0.03 and 0.006 respectively), but not tube type (P-value = 0.8). Multivariable analysis confirmed that older age and complex probing were associated with higher failure rates in CNLDO cases, with each monthly increase correlating to a two percent higher likelihood of intubation failure. ConclusionsPatient age and probing complexity influence CNLDO treatment, impacting surgical techniques and outcomes. Tube type, prior surgery, and passive smoking have no significant impact on treatment success.

Indications and success rate of endotracheal emergency intubation in clinical acute and emergency medicine

Securing the airway in the emergency department (ED) is ahigh-stakes procedure; however, the primary success and complication rate are largely unknown in Germany. The aim of this study was aretrospective analysis of prospectively collected resuscitation room data for endotracheal intubation (ETI) regarding indications, performance and complications. Between 1 January 2020 and 30 June 2023 all ETIs conducted in the ED (Kliniken Maria Hilf, Moenchengladbach, Germany) were analyzed following approval by the ethics committee (EK 23-369). Primary intubations performed by the anesthesiology department were excluded. The core medical team of the ED underwent asix-week training program including atwo-week anesthesia rotation prior to performing ETI in the ED. There were standard operating procedures (SOP) for both rapid sequence induction (RSI) and airway exchange with aplaced laryngeal tube (LT) utilizing video laryngoscopy (C-Mac, Storz), rocuronium for relaxation and primary intubation with an elastic bougie. The primary success rate, overall success rate and intubation-related complications were analyzed. Additionally, the factor of consultant ED staff and residents was evaluated with respect to the primary success rate. During the study period 499 patients were intubated by the core ED team and 28patients underwent airway exchange from LT to ETI. Primary success could be achieved in 489/499 (98.0%) ETI and in 25/28 (89.3%) LT exchange patients. Surgically achieved securing of the airway was carried out in 5/527 (0.9%) patients in a cannot intubate situation and 11/527(2.2%) patients suffered cardiac arrest minutes after the ETI. The overall first pass success rate of endotracheal tube placement was 514/527 (97.4%). The comparison of the primary success of consultants (168/175; 96.0%) vs. residents 320/325 (98.5%) yielded no significant differences (p = 0.08). In clinical acute and emergency medicine, astandardized approach utilizing video laryngoscopy and a bougie following astructured training concept, can achieve an above-average high primary success rate with simultaneous low severe complications in the high-risk collective of critically ill emergency patients in an intrahospital setting.