scholarly journals Direct Laryngoscopy or Video Laryngoscopy: Which Is Better for Performing Endotracheal Intubation?

2021 ◽  
Author(s):  
Zahid Hussain Khan ◽  
Kasra Karvandian ◽  
Haitham Mustafa Muhammed
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
High Morbidity ◽  
Success Rates ◽  
Failed Intubation ◽  
Airway Control ◽  
New Device ◽  
Manual Search

Background: Endotracheal intubation is known as the best and challenging procedure to airway control for patients in shock or with unprotected airways. Failed intubation can have serious consequences and lead to high morbidity and mortality of the patients. Videolaryngoscope is a new device that contains a miniaturized camera at the blade tip to visualize the glottis indirectly. Fewer failed intubations have occurred when a videolaryngoscope was used. Other types of videolaryngoscopes were then developed; all have been shown to improve the view of the vocal cords. It may be inferred that for the professional group, including emergency physicians, paramedics, or emergency nurses, video laryngoscopy may be a good alternative to direct laryngoscopy for intubation under difficult conditions. The incidence of complications was not significantly different between the C-MAC 20% versus direct laryngoscopy 13%. The main goal of this review was to compare the direct laryngoscopy with the (indirect) video laryngoscopy in terms of increased first success rate and good vision of the larynx to find a smooth induction of endotracheal intubation. Methods: Currently available evidence on MEDLINE, PubMed, Google scholar and Cochrane Evidence Based Medicine Reviews, in addition to the citation reviews by manual search of new anesthesia and surgical journals related to laryngoscopies and tracheal intubation. Results: This review of recent studies showed that the laryngoscopic device design would result in smooth approach of endotracheal intubation by means of good visualization of glottis and the best success rates in the hands of both the experienced and novice. Video laryngoscopes may improve safety by avoiding many unnecessary attempts when performing tracheal intubation with DL compared to VL as well as easy learning of both direct and indirect laryngoscopy. Conclusion: The comparative studies of different video laryngoscopes showed that DL compared with VL, reveal that video laryngoscopes reduced failed intubation in anticipated difficult airways, improve a good laryngeal view and found that there were fewer failed intubations using a videolaryngoscope when the intubator had equivalent experience with both devices, but not with DL alone. And therefore, knowledge about ETI and their skills, are crucial in increasing the rate of survival.

scholarly journals Comparative Effectiveness of the C-MAC Video Laryngoscope versus  Direct Laryngoscopy in the Setting of the Predicted Difficult Airway

2012 ◽  
Vol 116 (3) ◽  
pp. 629-636 ◽  
Author(s):  
Michael F. Aziz ◽  
Dawn Dillman ◽  
Rongwei Fu ◽  
Ansgar M. Brambrink
Keyword(s):  
Tracheal Intubation ◽  
Difficult Airway ◽  
Difficult Intubation ◽  
Direct Laryngoscopy ◽  
Controlled Trial ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Success Rates ◽  
Intubation Success ◽  
Intubation Success Rate

Background Video laryngoscopy may be useful in the setting of the difficult airway, but it remains unclear if intubation success is improved in routine difficult airway management. This study compared success rates for tracheal intubation with the C-MAC® video laryngoscope (Karl Storz, Tuttlingen, Germany) with conventional direct laryngoscopy in patients with predicted difficult airway. Methods We conducted a two arm, single-blinded randomized controlled trial that involved 300 patients. Inclusion required at least one of four predictors of difficult intubation. The primary outcome was successful tracheal intubation on first attempt. Results The use of video laryngoscopy resulted in more successful intubations on first attempt (138/149; 93%) as compared with direct laryngoscopy (124/147; 84%), P = 0.026. Cormack-Lehane laryngeal view was graded I or II in 139/149 of C-MAC attempts versus 119/147 in direct laryngoscopy attempts (P < 0.01). Laryngoscopy time averaged 46 s (95% CI, 40-51) for the C-MAC group and was shorter in the direct laryngoscopy group, 33 s (95% CI, 29-36), P < 0.001. The use of a gum-elastic bougie and/or external laryngeal manipulation were required less often in the C-MAC intubations (24%, 33/138) compared with direct laryngoscopy (37%, 46/124, P = 0.020). The incidence of complications was not significantly different between the C-MAC (20%, 27/138) versus direct laryngoscopy (13%, 16/124, P = 0.146). Conclusion A diverse group of anesthesia providers achieved a higher intubation success rate on first attempt with the C-MAC in a broad range of patients with predictors of difficult intubation. C-MAC laryngoscopy seems to be a useful technique for the initial approach to a potentially difficult airway.

Success of Intubation Rescue Techniques after Failed Direct Laryngoscopy in Adults

2016 ◽  
Vol 125 (4) ◽  
pp. 656-666 ◽  
Author(s):  
Michael F. Aziz ◽  
Ansgar M. Brambrink ◽  
David W. Healy ◽  
Amy Wen Willett ◽  
Amy Shanks ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy ◽  
Perioperative Outcomes ◽  
Supraglottic Airway ◽  
Fiberoptic Intubation ◽  
Success Rates ◽  
Intubation Success Rate ◽  
Lighted Stylet

Abstract Background Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Methods Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. Results A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope® [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. Conclusions Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

scholarly journals Comparison of GlideScope Video Laryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Neonates

2019 ◽  
Vol 129 (2) ◽  
pp. 482-486 ◽  
Author(s):  
Bingdong Tao ◽  
Kun Liu ◽  
Ping Zhao ◽  
Dandan Wang ◽  
Yiming Liu ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy

scholarly journals First attempt success of video versus direct laryngoscopy for endotracheal intubation by ambulance nurses: a prospective observational study

2020 ◽  
Vol 46 (5) ◽  
pp. 1039-1045 ◽  
Author(s):  
Wim Breeman ◽  
Mark G. Van Vledder ◽  
Michael H. J. Verhofstad ◽  
Albert Visser ◽  
Esther M. M. Van Lieshout
Keyword(s):  
Success Rate ◽  
Endotracheal Intubation ◽  
Direct Laryngoscopy ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Spontaneous Circulation ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Direct Laryngoscope ◽  
Positive Effect

Abstract Purpose The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS)  of 3 using video laryngoscopy versus direct laryngoscopy. Methods A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation. Results The first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001). Conclusion Although no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.

scholarly journals The midline approach for endotracheal intubation using GlideScope video laryngoscopy could provide better glottis exposure in adults： A randomized controlled trial

2019 ◽  
Author(s):  
Lianxiang Jiang ◽  
Shulin Qiu ◽  
Peng Zhang ◽  
Weidong Yao ◽  
Yan Chang ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Intubation ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Video Laryngoscopy ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Midline Approach ◽  
Approach Group

Abstract Background: Previous studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation. Methods: Two hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups. Results: Finally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments ( P >0.05). Compared with Group R, Group M had a better CLV ( χ2 =14.706, P =0.001) and shorter times to glottis exposure (8.82±2.04 vs 12.38±1.81; t =14.94; P <0.001) and tracheal intubation (37.19±5.01 vs 45.23±4.81; t =13.25; P <0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 =0.074; P =0.446) and intubation procedure time (29.86±2.56 vs 30.46±2.97, t =1.75, P =0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference ( P >0.05). Conclusion: Although the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation. Trial registration: The study was registered in the Chinese Clinical Trial Registry ( ChiCTR-RNC-1900023252 ).

scholarly journals EXPERIENCE OF VIDEO LARYNGOSCOPY DURING TRACHEAL INTUBATION FOR EMERGENCY INDICATIONS IN THE PRACTICE OF AN ANESTHESIOLOGIST AND RESUSCITATOR

2020 ◽  
Vol 21 (3) ◽  
pp. 33-38
Author(s):  
V. V. Vasilev
Keyword(s):  
Tracheal Intubation ◽  
Difficult Intubation ◽  
Direct Laryngoscopy ◽  
Successful Intubation ◽  
Failed Intubation ◽  
Advantages And Disadvantages ◽  
Lehane Grade ◽  
Grade Ii ◽  
The Mean ◽  
Technical Solutions

Objectives. To assess the advantages and disadvantages of videolaryngoscopy as one of methods of tracheal intubation which is being widely used as an alternative to direct laryngoscopy in anesthesiologist’s practice.Material and methods. Over 100 of tracheal intubations were conducted with the use of videolaryngoscope, along with a routine use of the direct laryngoscopy. The results of 48 intubations are discussed. 4 clinical cases are presented in this article.Results. Cormack-Lehane grade I view was obtained in 39 cases (81,3%), Cormack-Lehane grade II - in 9 patients (18,8%). First attempt intubation was performed in 43 cases (89,6%), in 4 cases intubation was successful after second attempt (8,3%), failed intubation was in 1 case (2,1%). The mean duration of successful intubation was 36,9 sec. Certain difficulties occured during intubation related with the advancement of the endotracheal tube. Technical solutions are given for some of intraprocedural conditions.Conclusions. Videolaryngoscopy is a safe and effective method of tracheal intubation. Although this method is not lacking in disadvantages it has a number of advantages, main of which is the improved larynx visualization. In our opinion, this method can not completely replace direct laryngoscopy in anesthesiolodist’s practice, but may serve as an adjuvant in case of difficult intubation.

Comparison of GlideScope Video Laryngoscopy and Direct Laryngoscopy for Tracheal Intubation in Neonates

2020 ◽  
Vol 40 (1) ◽  
pp. 39
Author(s):  
B. Tao ◽  
K. Liu ◽  
P. Zhao ◽  
D. Wang ◽  
Y. Liu ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Direct Laryngoscopy ◽  
Video Laryngoscopy

Comparison of Video Laryngoscopy and Direct Laryngoscopy in the Success of Intubation Performed by Novice Personnel in Patients with Cervical Immobilization: A Manikin Study

2021 ◽  
Author(s):  
Özge Can ◽  
Sercan Yalcinli ◽  
Yusuf Ali Altunci
Keyword(s):  
Success Rate ◽  
Direct Laryngoscopy ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
First Year ◽  
Success Rates ◽  
Significant Difference ◽  
Intubation Success ◽  
Cervical Immobilization ◽  
Second Year

Introduction: Pre-hospital intubation is a challenging but essential intervention. During intubation, it is difficult to identify vocal cords when using a cervical collar and trauma board. Therefore, the success rate of intubation by paramedics decreases in trauma patients. Video laryngoscopy increases intubation success rate and has been recommended for difficult airways in studies. Objective: In this study, we compared the intubation success rates when using a video laryngoscope and a direct laryngoscope in a manikin with simulated cervical immobilization.  Methods: In this cross-sectional study, the manikin’s neck collar and spine board created a complicated airway model with cervical immobilization. Inexperienced paramedic students tried intubation with both methods, and their trial periods were recorded. Students answered a question evaluating the convenience of the procedure for both methods after the trial. Results: In this study, 83 volunteers, who were first-year and second-year paramedics, participated; 32 (38.6%) of the volunteers were first-year students, while 51 (61.4%) were second-year students. All volunteers had previous intubation experience with direct laryngoscopy, but not with video laryngoscopy. There was a statistically significant difference in the first-attempt success rates of the procedure between the groups in favor of video laryngoscope (p=0.022). Note that there was no significant difference between the groups in terms of first attempt durations (p=0.337). Conclusion: Video laryngoscopy in airway management can increase the success rate of first-attempt intubation by inexperienced pre-hospital healthcare personnel.

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