Use Of Video Laryngoscopy Research Articles

EARLY TEACHING AND ADOPTION OF VIDEOLARYNGOSCOPY IN EMERGENCY MEDICINE TRAINING.

The aim of this paper is to gather and evaluate available literature about using videolaryngoscopy as a training tool for novice learners and compare it to direct laryngoscopy. Search of the available literature was performed using the MEDLINE database, through the PubMed searching tool. The inclusion criteria were that papers had to be original research and participants had to be novices in the field of airway management. The studies also had to pertain to the topic of using videolaryngoscopy as a training tool, therefore all papers that evaluated performance of videolaryngoscopy in clinical applications or did not pertain to using videolaryngoscopy as a training tool were excluded from this review. Five studies were identified that fitted the inclusion criteria, all of which showed a statistically significant difference in first attempt success at endotracheal intubation in favor of videolaryngoscopy when compared to direct laryngoscopy. One of the studies also demonstrated a faster skill acquisition rate when using videolaryngoscopy. The use of videolaryngoscopy in teaching airway management to trainees (emergency medicine residents included) is a viable option and should be encouraged and researched further.

State of implementation of the Corona-Virus-Disease-2019 resuscitation guidelines : An online-based survey one year after publication in Germany.

The present study evaluated the implementation of the European Resuscitation Council Corona-Virus-Disease 2019 (COVID-19) resuscitation guidelines in Germany 1 year after publication. To evaluate the practical implementation of the COVID-19 resuscitation guidelines in Germany one year after their publication. In an online survey between April and May 2021participants were asked about awareness of COVID-19 resuscitation guidelines, corresponding training, the resuscitation algorithm used and COVID-19 infections of emergency medicine personnel associated with COVID-19 resuscitation. Atotal of 961 (8%) of the 11,000 members took part in the survey and 85% (818/961) of questionnaires were fully completed. While 577 (70%) of the respondents were aware of the COVID-19 guidelines, only 103 (13%) had received respective training. Aspecific COVID-19 resuscitation algorithm was used by 265 respondents (32%). Adaptations included personal protective equipment (99%), reduction of staff caring for the patient, or routine use of video laryngoscopy for endotracheal intubation (each 37%), securing the airway before rhythm analysis (32%), and pausing chest compressions during endotracheal intubation (30%). Respondents without aspecific COVID-19 resuscitation algorithm were more likely to use mouth-nose protection (47% vs. 31%; p < 0.001), extraglottic airway devices (66% vs. 55%; p = 0.004) and have more than 4team members close to the patient (45% vs. 38%; p = 0.04). Use of an Filtering-Face-Piece(FFP)-2 or FFP3 mask (89% vs. 77%; p < 0.001; 58% vs. 70%; p ≤ 0.001) or performing primary endotracheal intubation (17% vs. 31%; p < 0.001) were found less frequently and 9% reported that ateam member was infected with COVID-19 during resuscitation. The COVID-19 resuscitation guidelines are still insufficiently implemented 1 year after publication. Future publication strategies must ensure that respective guideline adaptations are implemented in atimely manner.

A prospective cohort evaluation of the McGrath™ MAC videolaryngoscope in a series of 979 cases

BackgroundEvidence favouring the effectiveness of videolaryngoscopes over conventional direct laryngoscopy for facilitating successful tracheal intubation has been growing. However, to choose between different devices, clinicians need to know how individual devices perform outside of carefully controlled clinical trials. AimTo evaluate the effectiveness of the McGrath MAC videolaryngoscope as it was introduced into clinical practice. MethodsCohort evaluation of McGrath MAC videolaryngoscope use in clinical practice by voluntary completion of an evaluation form over a two-year period. ResultsIn a total of 979 cases, tracheal intubation was successful in 955/979 (97.5%), with first pass success achieved in 785/955 (82.2%). Most tracheal intubations (964/979, 80.1%) were performed during ‘office hours’ (Monday to Friday 0800-1800). Senior anaesthetists conducted 423/970 (43.6%) of intubations. There were 24/979 (2.5%) failed intubations, with consultants or senior anaesthetists conducting laryngoscopy in the majority of these; in 16/22 failed intubations, a grade I or II glottic view was obtained on the videolaryngoscope screen. Of the 20 anaesthetists involved as intubators, 14 had used the device fewer than 50 times. ConclusionOur historical results demonstrate the effectiveness and feasibility of using the McGrath MAC videolaryngoscope to facilitate tracheal intubation in clinical practice. However, we believe the most important finding was the number of “easy” grade I and II glottic views on videolaryngoscopy where tracheal intubation was not achieved. Our experience and the evidence suggest that in order to fully realise the numerous benefits of videolaryngoscopy, the introduction of formal teaching and instruction by trained trainers is essential.

Comparison of the C-MACTM ‘D’ blade with AirTraq® for endotracheal intubation in patients with simulated limitation of cervical movements

Background: Direct laryngoscopy and tracheal intubation with manual in-line stabilisation is the standard practice for trauma victims while securing the airway when cervical injury/instability is suspected. The use of videolaryngoscopes eliminates the need to align the three axes, avoids movement at cervical joints, allows viewing around the corner and improves glottic view. Aim: Comparison of C-MACTM‘D’Blade and AirTraq® for endotracheal intubation in patients with simulated limitation of cervical movements. Methodology: This was a prospective, randomised study conducted on 52 consenting patients requiring intubation. They were assigned to undergo intubation using C-MACTM‘D’Blade (n=26) or AirTraq® (n=26) by an anaesthesiologist experienced in the use of both laryngoscopes while MILS was provided. Results: Laryngoscopic view was similar in the two groups: grade 1 in 16 (61.5%) and 21 patients (81.8%) in the ‘D’blade and AirTraq® groups respectively with the remaining having a grade 2 view. The median time for laryngoscopy was less (13 s) in the ‘D’ blade compared to AirTraq® group (19.6 s) and was statistically significant (p= 0.036) but clinically insignificant. The intubation time was comparable (p=0.094). Most patients in both groups were intubated successfully in the first attempt. Requirement of airway manipulation to optimise view, postoperative sore throat and blood on the endotracheal tube was comparable. Good overall satisfaction score was obtained in bothgroups. Conclusion: Both C-MACTM ‘D’Blade and AirTraq® when used for intubation in patients with simulated limitation of cervical movements provide similar videolaryngoscopic view, time for laryngoscopy and intubation, and overall satisfaction score.

Implementation of video laryngoscopes and the development in airway management strategy and prevalence of difficult tracheal intubation: A national cohort study.

We aimed to determine the development in the use of video laryngoscopy over a 9-year period, and its possible impact on airway planning and management. We retrieved 822,259 records of tracheal intubations recorded from 2008 to 2016 in the Danish Anaesthesia Database. The circumstances regarding pre-operative airway assessment, the scheduled airway management plan and the actual airway management concerning video laryngoscopy were reported for each year of observation. Further, the association between year of observation and various airway management related outcomes was evaluated by multivariate logistic regression. There was a significant increase in airway management with 'advanced technique successfully used within two attempts' from 2.7% in 2008 to 15.5% in 2016 (p <.0001). This predominantly reflects use of video laryngoscopy. The prevalence of tracheal intubations 'scheduled for video laryngoscopy' increased from 3.5% in 2008 to 10.6% in 2016 (p <.0001). We found a significant increase in the prevalence of anticipated difficulties with intubations by direct laryngoscopy from 1.8% in 2008 to 5.2% in 2016 (p <.0001). The prevalence of failed tracheal intubations decreased from 0.14% in 2008 to 0.05% in 2016 (p <.0001). From 2008 to 2016, a period of massive implementation of video laryngoscopes, a significant change in airway management behaviour was recorded. Increasingly, video laryngoscopy is becoming a first-choice device for both acute and routine airway management. Most importantly, the data showed a noticeable reduction in failed intubation over the time of observation.

Risk of peri-intubation adverse events during emergency department intubation of overdose patients: a national emergency airway registry (near) analysis

Background More than 20,000 emergency department (ED) patients undergo intubation for overdose each year. While the characteristics of patients intubated for overdose and poisoning are well described, little is known about the intubation outcomes of overdose patients in the ED. Objectives We quantify the frequency of peri-intubation adverse events for patients intubated in the ED for overdose, and determine whether first attempt success without adverse events differs between patients intubated for overdose and patients intubated for other reasons. Methods We analyzed data from the National Emergency Airway Registry (NEAR), a prospective multicenter registry of ED intubations collected from an international network of 22 academic and community hospitals. We included patients 14 years and older whose first attempt was oral intubation, with data entered into NEAR between 1 January 2016 and 31 December 2018. The primary outcome was successful intubation on the first attempt. We used multivariable logistic regression to determine whether indication was independently associated with successful intubation on the first attempt after adjusting for age, gender, obesity, initial impression of difficult airway, presence of difficult airway characteristics, and use of video laryngoscopy. Secondary outcomes included successful intubation on the first attempt without adverse events, the occurrence of rescue surgical airways, and the occurrence of adverse events. Adverse events included hypoxemia, hypotension, peri-intubation cardiac arrest, bradycardia, mechanical injury to oral or airway structures, vomiting, tachydysrhythmia, esophageal intubation, laryngospasm, and pneumothorax. Results We analyzed 17,984 patients, including 1,983 (11%) intubated for overdose, and 16,001 (89%) intubated for other indications. Patients intubated for overdose were younger (median age 38 vs 55 years), were less frequently obese (26% vs 34%), and fewer had difficult airway characteristics (38% vs 53%). Overdose patients were more likely to have preoxygenation performed (45% vs 35%), more likely to have apenic oxygenation (39% vs 31%), and more likely to have bougie used (33% vs 17%). First attempt success was 90.5% in patients intubated for overdose and 87.5% in patients intubated for other reasons (absolute difference 3.0%; 95% CI: −1.3 to 7.3). First attempt success without adverse events was higher in overdose patients (85.0%) compared to other patients (78.7%) (absolute difference, 6.3%; 95% CI 1.0 to 11.7%). Overdose patients experienced significantly less hypotension (1.5% vs 4.1%), and tended to have fewer adverse events overall. Multivariable model results were consistent with the unadjusted results including no difference in first pass success (adjusted odd ratio 1.02 [95% CI 0.86–1.23]). There was a higher first pass success without complication in patients intubated for overdose (adjusted odds ratio 1.23; 95% CI 1.07 to1.43). Conclusion For patients in whom the primary indication for intubation is overdose there is an increased chance of first attempt success without adverse event.

Perioperative Management for Emergency Surgery in Pediatric Patients with COVID-19: Retrospective Observational Study.

BackgroundThe first wave of COVID-19 in 2020 created massive challenges in providing safe surgery for pediatric patients with COVID-19. Inevitably, emergency surgery and the unknown nature of the disease place a burden on the heavily challenged surgical services for pediatrics in a developing country. Lessons from the pandemic are important for future disaster planning.AimTo describe the characteristics of pediatric surgical patients with COVID-19 undergoing emergency surgery during the first wave and its perioperative narrative in a developing country.MethodsThe study was a multicenter retrospective descriptive study in eight Indonesian government-owned referral and teaching hospitals. The authors reviewed confirmed COVID-19 pediatric patients (≤18 years old) who underwent surgery. Institutional review board clearances were acquired, and data were evaluated in proportion and percentages. The writing of this paper follows the STROBE guidelines.ResultsAbout 7791 pediatric surgical cases were collected, 73 matched the study criteria and 24 confirmed cases were found. Cases were more common in females (58.3%), who were above 12 years old (37.5%) and who were asymptomatic (62.5%). Laparotomy (33.3%), general anesthesia (90.4%) and intubation (80.8%) were common, while use of video laryngoscopy (40%) and rapid sequence intubation (28.8%) were rare. The mean length of stay was 12 ±13.3 days, and in-hospital mortality was 8.3%.DiscussionsLockdown and school closure were successful in protecting children, hence the low incidence of pediatric surgical cases with COVID-19 during the first wave. Many hospitals were unprepared to perform surgery for a droplet or airborne infectious disease, and COVID-19 testing was not available nationally in the early pandemic, hence the use of protective protection equipment during these early pandemic times are often not efficient.ConclusionThe incidence of COVID-19 in pediatric surgical patients is low. The rapidity and availability of preoperative testing for a new emerging disease are essential in a pandemic.

Optimal depth of electromyographic endotracheal tube: A novel approach using video laryngoscopy.

Electromyographic (EMG) endotracheal tubes with surface electrodes are used during neck surgery to prevent recurrent laryngeal nerve (RLN) injury. Proper positioning of the EMG tube is of paramount importance. In this study, we aimed to compare the use of video laryngoscopy with other methods for achieving the optimal depth of the EMG tube. We retrospectively enrolled 489 adult patients (with 675 nerves at risk [NAR]) undergoing surgery using the EMG endotracheal tube. Patients were categorized into three groups with: rigid laryngoscope (n = 140, NAR = 187), conventional laryngoscope (n = 262, NAR = 370), and video laryngoscope (n = 87, NAR = 118). A formula for predicting optimal depths of the EMG tube was obtained from data of the standard group with rigid laryngoscope. Depths of the EMG endotracheal tube were measured and postoperative RLN injuries were analyzed. Based on linear regression, the formula was derived for predicting the optimal depth of EMG endotracheal tube (cm) = 11.028 + 0.635 * gender (female = 0; male = 1) + 0.069 * height (cm). Compared to conventional laryngoscope, intubation of EMG tube with video laryngoscope resulted in less discrepancy between its actual value and optimal value, and the tube depth was more correct (OR = 2.888, 95% CI = 1.753-4.757, p < 0.001). All five postoperative permanent RLN injuries were found in the group with conventional laryngoscope. EMG endotracheal tube insertion with video laryngoscopy is superior to conventional laryngoscopy, as well as an alternative to rigid laryngoscopy. The video laryngoscopy is a novel approach to get optimal depth of EMG endotracheal tube during neck surgery.

Airway Management of Patients with Suspected or Confirmed COVID-19: Survey Results from Physicians from 19 Countries in Latin America.

Airway management during the COVID-19 pandemic has been one of the most challenging aspects of care that anesthesiologists and intensivists face. This study was conducted to evaluate the management of tracheal intubation in patients with suspected or confirmed COVID-19 infection. This is a cross-sectional and international multicenter study based on a 37-item questionnaire. The survey was available to physicians who had performed intubations and tracheostomies in patients with suspected or confirmed COVID-19 and had provided informed consent to participate. The primary outcome is the preference to use a specific device for tracheal intubation. Secondary outcomes are clinical practice variables, use of video laryngoscopes, difficult airway management, and safety features to prevent cross-infection. This study included 2411 physicians who performed an average of 11.90 and 20.67 tracheal intubations in patients diagnosed or suspected of having COVID-19 disease, respectively. Physicians were mainly from the specialties of Anesthesiology (61.2%) and Intensive Care (7.4%). COVID-19 infection diagnosed by positive PCR or serology in physicians participating in intubation in this study was 15.1%. Respondents considered preoxygenation for more than three minutes very useful (75.7%). The preferred device for tracheal intubation was the video laryngoscope (64.8%). However, the direct laryngoscope (57.9%) was the most commonly used, followed by the video laryngoscope (37.5%). The preferred device to facilitate intubation was the Eschmann guide (34.2%). Percutaneous tracheostomy was the preferred technique (39.5%) over the open tracheostomy (22%). The predicted or unpredicted difficult airway management in these patients was preferably performed with a video laryngoscope (61.7% or 63.7, respectively). Intubation was mostly performed by two or more expert airway physicians (61.6%). The use of personal protective equipment increased the practitioners’ discomfort during intubation maneuvers. The video laryngoscope is the preferred device for intubating patients with COVID-19, combined with the Eschmann guide, flexible stylet within the endotracheal tube, or Frova guide to facilitate intubation. The sub-analysis of the two groups of physicians by the level of intubation experience showed a higher use of the video laryngoscope (63.4%) in the experts group and no significant differences between the two groups in terms of cross-infection rates in physicians, in their preference for the use of the video laryngoscope or in the number of intubations performed in confirmed or suspected COVID-19 patients.

Does videolaryngoscopy improve tracheal intubation first attempt success in the NICUs? A report from the NEAR4NEOS.

ObjectiveWe hypothesized that videolaryngoscope use for tracheal intubations would differ across NICUs, be associated with higher first attempt success and lower adverse events.Study designData from the National Emergency Airway Registry for Neonates (01/2015 to 12/2017) included intubation with direct laryngoscope or videolaryngoscope. Primary outcome was first attempt success. Secondary outcomes were adverse tracheal intubation associated events and severe desaturation.ResultsOf 2730 encounters (13 NICUs), 626 (23%) utilized a videolaryngoscope (3% to 64% per site). Videolaryngoscope use was associated with higher first attempt success (p < 0.001), lower adverse tracheal intubation associated events (p < 0.001), but no difference in severe desaturation. After adjustment, videolaryngoscope use was not associated with higher first attempt success (OR:1.18, p = 0.136), but was associated with lower tracheal intubation associated events (OR:0.45, p < 0.001).ConclusionVideolaryngoscope use is variable, not independently associated with higher first attempt success but associated with fewer tracheal intubation associated events.

Case report: Airway management in post corrosive poisoning

Corrosive substance ingestion in the acute phase may result in laryngeal injury, endotracheal or bronchial necrosis with mediastinitis, esophagus perforation. Most common late complications are fibrosis and strictures. Pharyngeal web is a rare anamoly which can be seen congenitally or after corrosive ingestion characterized by mucosal bands extending from the posterior pharyngeal wall anteriorly to the glottis. Challenges in anaesthetic management includes securing difficult airway due to distorted upper airway anatomy. Here, we report a case of pharyngeal web where we safely secured airway without injury to the webs with the use of video laryngoscope.

A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.

There are limited data on the use of video laryngoscopy for pediatric patients outside of the operating room. Our primary aim was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events. This is a pre-post observational study of video laryngoscopy implementation with standardized coaching language for tracheal intubation in a single-center, pediatric intensive care unit. The use of video laryngoscopy as a coaching device with standardized coaching language was implemented as a part of practice improvement. All patients in the pediatric intensive care unit were included between January 2016 and December 2017 who underwent primary tracheal intubation with either video laryngoscopy or direct laryngoscopy. The uptake of the implementation, sustained compliance, tracheal intubation outcomes including all adverse tracheal intubation-associated events, oxygen desaturations (<80% SpO2), and first attempt success were measured. Among 580 tracheal intubations, 284 (49%) were performed during the preimplementation phase, and 296 (51%) postimplementation. Compliance for the use of video laryngoscopy with standardized coaching language was high (74% postimplementation) and sustained. There were no statistically significant differences in adverse tracheal intubation-associated events between the two phases (pre- 9% vs. post- 5%, absolute difference -3%, CI95 : -8% to 1%, p=.11), oxygen desaturations <80% (pre- 13% vs. post- 13%, absolute difference 1%, CI95 : -6% to 5%, p=.75), or first attempt success (pre- 73% vs. post- 76%, absolute difference 4%, CI95 : -3% to 11%, p=.29). Supervisors were more likely to use the standardized coaching language when video laryngoscopy was used for tracheal intubation than with standard direct laryngoscopy (80% vs. 43%, absolute difference 37%, CI95 : 23% to 51%, p < .001). Implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with high level of adherence, yet not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.

Video laryngoscope-guided urethral catheterization in female minipigs.

The objective of this work was to anatomically locate the urethral orifice in female minipigs and describe the use of video laryngoscopes in urethral catheterization. Urethral catheterization guided by a video laryngoscope was attempted in 16 adult female Bama minipigs. The anatomical location of urethral orifices, operating time and complications (mucosal edema and bleeding in the vaginal vestibule, and the numbers of red blood cells (RBCs) and white blood cells (WBCs) in mid-stream urine samples) were recorded. The anatomical location of the urethral orifice: the depth of the urethral orifice in female Bama minipigs was 4.2 ± 1.2 cm; all the urethral orifices were covered by mucosal folds of the vaginal vestibule. In the supine position, the orifice of the urethra at 9-12 and 1-3 o'clock accounted for 6.25%, 6.25%, 18.75%, 50%, 12.5%, 6.25% and 6.25%, respectively. All animals were successfully catheterized and the operating time was 9.0 (6.0-12.8) min. Complications: no bleeding in the vaginal vestibule was observed; the incidence of mucosal edema was 12.5%, all of which were mild; of urine samples collected 1 h after catheterization, 12.5% were found to contain RBCs and no RBCs were detected 6 h after catheterization; no WBCs were detected 1 h or 6 h after catheterization. The urethral orifice of female minipigs was located deep in the vagina at variable clock directions and was unexceptionally covered by mucosal folds. Applying a video laryngoscope in urethral catheterization allowed quick and accurate exposure of the urethral orifice and minimal operational injury in female minipigs.

P.31 Evaluating the impact of an induction checklist on videolaryngoscopy use as a first line intubation device

P.31 Evaluating the impact of an induction checklist on videolaryngoscopy use as a first line intubation device

Re-creating reality: validation of fresh frozen full cadaver airway training with videolaryngoscopy and bougie FIRST strategy

BackgroundTracheal intubation is the gold standard in emergency airway management. One way of measuring intubation quality is first pass success rate (FPSR). Mastery of tracheal intubation and maintenance of the skill is challenging for non-anesthesiologists. A combination of individual measures can increase FPSR. Videolaryngoscopy is an important tool augmenting laryngeal visualization. Bougie-first strategy can further improve FPSR in difficult airways. Standardized positioning maneuvers and manipulation of the soft tissues can enhance laryngeal visualization. Fresh frozen cadavers (FFC) are superior models compared to commercially manufactured manikins. By purposefully manipulating FFCs, it is possible to mimic the pre-hospital intubation conditions of helicopter emergency medical service (HEMS).MethodsTwenty-four trauma surgeons (12 per Group, NOVICES: no pre-hospital experience, HEMS: HEMS physicians) completed an airway training course using FFCs. The FFCs were modified to match airway characteristics of 60 prospectively documented intubations by HEMS physicians prior to the study (BASELINE). In four scenarios the local HEMS airway standard (1: unaided direct laryngoscopy (DL), OLD) was compared to two scenarios with modifications of the intubation technique (2: augmented DL (bougie and patient positioning), 3: augmented videolaryngoscopy (aVL)) and a control scenario (4: VL and bougie, positioning by participant, CONTROL). FPSR, POGO score, Cormack and Lehane grade and duration of intubation were recorded. No participant had anesthesiological qualifications or experience in VL.ResultsThe comparison between CONTROL and BASELINE revealed a significant increase of FPSR and achieved C&L grade for HEMS group (FPSR 100%, absolute difference 23%, p ≤ .001). The use of videolaryngoscopy, bougie, and the application of positioning techniques required significantly more time in the CONTROL scenario (HEMS group: mean 34.0 s (IQR 28.3–47.5), absolute difference to BASELINE: 13.0 s, p = .045). The groups differed significantly in the median number of real-life intubations performed in any setting (NOVICES n = 5 (IQR 0–18.75), HEMS n = 68 (IQR 37.25–99.75)). In the control scenario no significant differences were found between both groups. The airway characteristics of the FFC showed no significant differences compared to BASELINE.ConclusionAirway characteristics of a pre-hospital patient reference group cared for by HEMS were successfully reproduced in a fresh frozen cadaver model. In this setting, a combination of evidence based airway management techniques results in high FPSR and POGO rates of non-anesthesiological trained users. Comparable results (FPSR, POGO, duration of intubation) were achieved regardless of previous provider experience. The BOAH concept can therefore be used in the early stages of airway training and for skill maintenance.

Comparison of aerosol box intubation with styletted endotracheal tube and intubation over bougie: A randomized controlled trial.

Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is an infectious disease. The use of video laryngoscopes is recommended for intubation of patients with COVID-19. But in resource-poor countries, it is rare to have video laryngoscopes available. In this trial, we have compared the ease of oral intubation by direct laryngoscopy with styletted endotracheal tube and intubation over the bougie, with the use of the aerosol box. The secondary objectives were comparison of the incidence of airway loss, attempts taken to intubate, time for intubation and hemodynamic changes. 80 non-coronavirus infected patients coming for an elective procedure under general anesthesia were recruited in this randomized control trial. Participants were assigned into groups S and B using a computer-generated random sequence of numbers by closed envelope technique. In both groups, aerosol box was used. In Group S, participants were intubated by direct laryngoscopy with a styletted endotracheal tube and in group B, after direct laryngoscopy, the endotracheal tube was railroaded over the bougie. Ease of endotracheal intubation was good (67.5%% vs. 45%), satisfactory (32.5%% vs. 37.5%), and poor (0% vs. 17.5%) in group S and B respectively (P < 0.011). The attempts required for intubation were similar in both groups. The time for intubation was significantly less in group S than B (23 vs. 55 s). The use of a styletted endotracheal tube made intubation easier and faster than tracheal intubation with bougie when the aerosol box was used in patients without known or predicted difficult airway and significant medical comorbidities.

Videographic Assessment of Tracheal Intubation Technique in a Network of Pediatric Emergency Departments: A Report by the Videography in Pediatric Resuscitation (VIPER) Collaborative

We sought to describe the tracheal intubation technique across a network of children's hospitals and explore the association between intubation technical adjuncts and first-attempt success as well as between laryngoscopy duration and the incidence of hypoxemia. We conducted a prospective observational study in 4 tertiary pediatric emergency departments of the Videography in Pediatric Resuscitation Collaborative. Children undergoing tracheal intubation captured on video were eligible for inclusion. Data on intubator background, patient characteristics, technical characteristics (eg, use of videolaryngoscopy and apneic oxygenation), and procedural outcomes were obtained through a video review. We obtained complete data on first attempts in 494 patients. The first-attempt success rate was 67%, the median laryngoscopy duration was 35 seconds (interquartile range 25 to 40), and hypoxemia occurred in 15% of the patients. Videolaryngoscopy was used for at least a part of the procedure in 48% of the attempts, and it had no association with success or the incidence of hypoxemia. Attempts in which videolaryngoscopy was used for the entire procedure (compared with direct laryngoscopy for the entire procedure) had a longer duration (the difference between the medians was 6 seconds; 95% confidence interval, 1 to 12 seconds). Intubation attempts longer than 45 seconds had a greater incidence of hypoxemia (29% versus 6%). Furthermore, apneic oxygenation was used in 8% of the first attempts. Among children undergoing tracheal intubation in a group of pediatric emergency departments, first-attempt success occurred in 67% of the patients. Videolaryngoscopy use was associated with longer laryngoscopy durations but was not associated with success or the incidence of hypoxemia.

First-Pass Success of Tracheal Intubation With Videolaryngoscopy in Head and Neck Cancer Patients: A Registry-Based Retrospective Cohort Study.

BackgroundThe incidence of difficult airway is higher in head and neck oncological surgery than in other surgeries. Limited evidence is available on the use of videolaryngoscopes in this cohort. A registry database on perioperative management of these patients was set up in our department in 2017.MethodsData from 2018 to 2019 were retrieved from this database. In 128 patients, videolaryngoscopy was used as the initial airway management of choice. Ease of intubation by first-pass success, its association with accessory manoeuvres, and complications were noted.ResultsOf the patients, 87% (n = 111) were successfully intubated with a videolaryngoscope in the first attempts. There was a strong association between the use of external laryngeal manipulation and successful first-pass intubation with videolaryngoscope. In patients with reduced inter-incisor distance, videolaryngoscope has shown greater benefit. There were very few complications including bleeding from the tumour site and a transient decrease in oxygen saturation to 88% in two patients.ConclusionVideolaryngoscopy was associated with high first-attempt intubation success and we recommend its use as the initial choice for airway management in head and neck cancer patients.

Airway management practices in COVID ICU during the first and second phases of the pandemic: our experience

Various airway management devices and techniques have been revised and recommended to be used in COVID patients.1 In India, during the first wave (April 2020 to November 2020)2 the intubation strategy included: consultant-led intubation teams, the use of video laryngoscope (VL) and aerosol box (AB).3 During the second wave (April 2021 to June 2021),2 the intubation procedures were modified according to the availability of the resources, manpower, and some experience gained from the first wave.&#x0D; Key words: Airway management; COVID-19; Pandemic; Intensive care&#x0D; Citation: Nazir N, Saxena A. Airway management practices in COVID ICU during the first and second phases of the pandemic: our experience. . Anaesth. pain intensive care 2021;25(6):834–835;&#x0D; DOI: 10.35975/apic.v25i6.1716 &#x0D;

The Use of Video Laryngoscopy Did Not Lead to Greater First-Pass or Overall Success Rates Compared to Direct Laryngoscopy in Pediatric Intubation in a Helicopter Emergency Medical Service

ObjectiveWe hypothesized that video laryngoscopy (VL) would significantly increase the first attempt and final success rates over direct laryngoscopy (DL) in helicopter emergency medical services. MethodsThis was a study of an emergency medical service in the Midwestern United States. Pediatric patients (age < 18 years) transported between January 1, 2010, and July 31, 2016, with an attempted intubation were identified. Demographics (age group and sex), first-pass success (FPS), and total attempts by intubation type were abstracted and compared with a historical control. ResultsFifty-five pediatric patient runs were abstracted (DL: n = 28, VL: n = 27). There were no significant differences between the DL and VL groups based on sex (DL: 54% male, VL: 70% male; P = .200) or age group (P = .239). Analyses of FPS between DL and VL showed no difference (DL: 82.1% success vs. VL: 70.4% success; P = .304). There was no difference for final success rate between DL and VL (DL: 85.7%, VL: 96.3%; P = .172). A significantly larger number of difficult airways were reported in the VL group (37.0%) compared with DL (7.1%, P = .007). ConclusionVL did not improve FPS over DL nor did it improve the final endotracheal intubation success rate over DL. The VL group had more airways reported as being difficult by the flight crew than the DL group.