Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway

2017 ◽  
Vol 127 (3) ◽  
pp. 432-440 ◽  
Author(s):  
Keyword(s):  
Difficult Airway ◽  
Observational Data ◽  
Odds Ratio ◽  
Fiber Optic ◽  
Supraglottic Airway ◽  
Intubation Attempt ◽  
Complication Rates ◽  
Success Rates ◽  
Intubation Technique ◽  
Difficult Airways

Abstract Background The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques. Methods Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy. Results Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt. Conclusions In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.

scholarly journals Proficiencies of Military Medical Officers in Intubating Difficult Airways

2020 ◽  
Author(s):  
Jonathan Zhao Min Lim ◽  
Shi Hao Chew ◽  
Benjamin Zhao Bin Chin ◽  
Raymond Chern Hwee Siew
Keyword(s):  
Difficult Airway ◽  
Success Rate ◽  
Graduate Training ◽  
Success Rates ◽  
Post Graduate ◽  
Airway Trauma ◽  
Intubation Success ◽  
Post Graduate Training ◽  
Difficult Airways ◽  
Mean Time

Abstract Background This study sheds light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method 133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s. Conclusion Military medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

scholarly journals Proficiencies of Military Medical Officers in Intubating Difficult Airways

2020 ◽  
Author(s):  
Jonathan Zhao Min Lim ◽  
Shi Hao Chew ◽  
Benjamin Zhao Bin Chin ◽  
Raymond Chern Hwee Siew
Keyword(s):  
Difficult Airway ◽  
Success Rate ◽  
Graduate Training ◽  
Success Rates ◽  
Post Graduate ◽  
Airway Trauma ◽  
Intubation Success ◽  
Post Graduate Training ◽  
Difficult Airways ◽  
Mean Time

Abstract Background This study sheds light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method 133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s. Conclusion Military medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

scholarly journals Proficiencies of military medical officers in intubating difficult airways

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jonathan ZM Lim ◽  
Shi Hao Chew ◽  
Benjamin ZB Chin ◽  
Raymond CH Siew
Keyword(s):  
Difficult Airway ◽  
Success Rate ◽  
Graduate Training ◽  
Success Rates ◽  
Post Graduate ◽  
Airway Trauma ◽  
Intubation Success ◽  
Post Graduate Training ◽  
Difficult Airways ◽  
Mean Time

Abstract Background This study sheds light on the proficiency of military medical officers who had received between 2 and 3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method One hundred thirty-three doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1 s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4 s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2 s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4 s. Conclusion Military medical officers with 2–3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

scholarly journals Comparison of Pentax-AWS®, Glidescope®, and King Vision® for difficult-airway intubation in manikins model by paramedics

2017 ◽  
Vol 24 (5) ◽  
pp. 237-243 ◽  
Author(s):  
Sanghyun Lee ◽  
Hyunggoo Kang ◽  
Jaehoon Oh ◽  
Tae Ho Lim ◽  
Yoonjae Lee ◽  
...  
Keyword(s):  
Difficult Airway ◽  
Success Rate ◽  
Potential Role ◽  
The Other ◽  
Success Rates ◽  
Glottic View ◽  
Different Types ◽  
Difficult Airways ◽  
The Impact

Introduction: Prehospital tracheal intubation of a difficult airway is challenging for paramedics. Thus far, the potential role of video laryngoscopes for this purpose has not been confirmed. Therefore, this study aimed to determine the impact of different types of video laryngoscopes on the success rate and time to intubation by paramedics. Methods: This is a prospective, randomized, crossover manikin study involving 18 paramedics. Participants performed intubation on a difficult airway in a high-fidelity manikin using Pentax-AWS®, Glidescope®, and King Vision® (with two blade types). Time to intubation and success rate of intubation were determined. Participants also rated the best glottic view and reported their preferences of devices. Results: In a difficult-airway scenario, the median time to intubation with Pentax-AWS® was 22.9 s (interquartile range, 19.5–24.9 s), which was significantly shorter than using other devices. There were no significant differences in the time to maximal exposure of the vocal cords between four devices ( p = 0.156). The time to insert the endotracheal tube with Pentax-AWS® and King Vision® with a guide-channel blade was significantly shorter than that with the other two devices (all, p < 0.05). Pentax-AWS® and King Vision® with a guide-channel blade showed higher success rates than the other two devices ( p = 0.04). With regard to device preference, 14 participants preferred Pentax-AWS® among all devices analyzed. Conclusion: Pentax-AWS® could be an appropriate device for paramedics in cases of difficult airways, with high success rate.

scholarly journals Tracheal Tube-Mounted Camera Assisted Intubation vs. Videolaryngoscopy in Expected Difficult Airway: A Prospective, Randomized Trial (VivaOP Trial)

2021 ◽  
Vol 8 ◽  
Author(s):  
Jörn Grensemann ◽  
Emma Möhlenkamp ◽  
Philipp Breitfeld ◽  
Pischtaz A. Tariparast ◽  
Tanja Peters ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Randomized Trial ◽  
Difficult Airway ◽  
Tracheal Tube ◽  
Negative Impact ◽  
Prospective Randomized Trial ◽  
Success Rates ◽  
Blade Shape ◽  
Difficult Airways ◽  
End Tidal

Background: Tracheal intubation in patients with an expected difficult airway may be facilitated by videolaryngoscopy (VL). The VL viewing axis angle is specified by the blade shape and visualization of the larynx may fail if the angle does not meet anatomy of the patient. A tube with an integrated camera at its tip (VST, VivaSight-SL) may be advantageous due to its adjustable viewing axis by means of angulating an included stylet.Methods: With ethics approval, we studied the VST vs. VL in a prospective non-inferiority trial using end-tidal oxygen fractions (etO2) after intubation, first-attempt success rates (FAS), visualization assessed by the percentage of glottis opening (POGO) scale, and time to intubation (TTI) as outcome parameters.Results: In this study, 48 patients with a predicted difficult airway were randomized 1:1 to intubation with VST or VL. Concerning oxygenation, the VST was non-inferior to VL with etO2 of 0.79 ± 0.08 (95% CIs: 0.75–0.82) vs. 0.81 ± 0.06 (0.79–0.84) for the VL group, mean difference 0.02 (−0.07 to 0.02), p = 0.234. FAS was 79% for VST and 88% for VL (p = 0.449). POGO was 89 ± 21% in the VST-group and 60 ± 36% in the VL group, p = 0.002. TTI was 100 ± 57 s in the VST group and 68 ± 65 s in the VL group (p = 0.079). TTI with one attempt was 84 ± 31 s vs. 49 ± 14 s, p &lt; 0.001.Conclusion: In patients with difficult airways, tracheal intubation with the VST is feasible without negative impact on oxygenation, improves visualization but prolongs intubation. The VST deserves further study to identify patients that might benefit from intubation with VST.

scholarly journals Proficiencies of Military Medical Officers in Intubating Difficult Airways

2020 ◽  
Author(s):  
Jonathan Zhao Min Lim ◽  
Shi Hao Chew ◽  
Benjamin Zhao Bin Chin ◽  
Raymond Chern Hwee Siew
Keyword(s):  
Difficult Airway ◽  
Success Rate ◽  
Graduate Training ◽  
Success Rates ◽  
Post Graduate ◽  
Airway Trauma ◽  
Intubation Success ◽  
Post Graduate Training ◽  
Difficult Airways ◽  
Mean Time

Abstract Background This study sheds light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes. Method 133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study. Results The medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s. Conclusion Military medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

scholarly journals Proficiencies of Military Medical Officers in Intubating Difficult Airways

2020 ◽  
Author(s):  
Jonathan Zhao Min Lim ◽  
Shi Hao Chew ◽  
Benjamin Zhao Bin Chin ◽  
Raymond Chern Hwee Siew
Keyword(s):  
Difficult Airway ◽  
Success Rate ◽  
Graduate Training ◽  
Success Rates ◽  
Post Graduate ◽  
Airway Trauma ◽  
Intubation Success ◽  
Post Graduate Training ◽  
Difficult Airways ◽  
Mean Time

Abstract Introduction This study shed light on the proficiency of military medical officers who had received between 2-3 years of post-graduate training, in the handling of the difficult airway in a trauma manikin simulator using direct and video laryngoscopes.Method133 doctors from the Singapore Armed Forces Medical Officer Cadet Course were assessed using high-fidelity simulator models with standardised difficult airways (simulator with tongue-swelling and cervical collar). They used the Macintosh direct laryngoscope (DL), King Vision channelled-blade laryngoscope (KVC), King Vision non-channelled blade laryngoscope (KVNC), and the McGrath (MG) laryngoscope on the same model in a randomised sequence. The intubation success rates and time to intubation were recorded and analysed for the study.ResultsThe medical officers had a 71.4% intubation success rate with the DL on the difficult airway trauma simulator model and the mean time to intubation of 40.1s. With the KVC, the success rate is 86.5% with mean intubation time of 40.4s. The KVNC produced 24.8% success rate, with mean time to intubation of 53.2s. The MG laryngoscope produced 85.0% success rate, with a mean time of intubation of 37.4s.ConclusionMilitary medical officers with 2-3 years of post-graduate training had a success rate of 71.4% success rate intubating a simulated difficult airway in a trauma setting using a DL. Success rates were improved with the use of KVC and the MG laryngoscope, but was worse with the KVNC.

Factors Influencing Clinical Success Following Endovascular Treatment of Type II Endoleaks

2020 ◽  
pp. 084653712098110
Author(s):  
Ramin Hamidizadeh ◽  
Emeka Nzekwu ◽  
Oliver Halliwell
Keyword(s):  
Clinical Success ◽  
Strong Predictor ◽  
Graft Infection ◽  
Mortality Data ◽  
Complication Rates ◽  
Type Ii ◽  
Success Rates ◽  
Cyanoacrylate Glue ◽  
Embolic Agents ◽  
Predictor Of Success

Purpose: To compare long-term outcomes of transarterial (TA) and translumbar (TL) embolization of type II endoleaks (T2E) following EVAR, as well as factors that predict clinical success. Methods: 129 (mean age, 71.4y; range, 53-95) with T2E referred for embolization from August-2003 to December-2017 were retrospectively reviewed. One-hundred-eighty procedures were performed via TA (n = 139) and TL (n = 41) approaches, with 37 patients undergoing 51 reinterventions. Clinical success was defined as absence of endoleak and/or absence of aneurysm sac enlargement on follow-up imaging. Medical comorbidities, procedural data, embolic agents used, presence of successful sac embolization, and 30-day morbidity and mortality data were collected. Results: TL approaches had higher technical success (41/41 vs.122/139, p = .014). Clinical success rates were 52% (N = 58/111) and 62% (N = 23/37) for TA and TL procedures respectively ( p = .34). Looking at all procedures, sac embolization using n-butyl cyanoacrylate glue had higher clinical success compared to other embolic agents ( p = .017-.037). Successful sac access was a strong predictor of success for TA procedures (46/78 vs.12/33, p = .0379). 30-day complication rates were similar between TA (5.8%) and TL (4.9%) approaches. There was 1 death secondary to graft infection following TA embolization. Conclusions: Overall clinical success of TA and TL embolization when considering re-interventions is high. n-butyl cyanoacrylate glue had significantly higher success than other embolic agents ( p = .017-.037). Successful sac access was associated with success for TA procedures.

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