scholarly journals Pre-formed endotracheal tube and stepwise insertion for more successful intubation with video laryngoscopy

2021 ◽  
Vol 10 (2) ◽  
pp. 7-15
Author(s):  
Ahmed A Shorrab ◽  
Moustafa A Helal
Keyword(s):  
Endotracheal Tube ◽  
Video Laryngoscopy ◽  
Successful Intubation

Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE: A Preliminary High-fidelity Mannequin Study

2015 ◽  
Vol 30 (3) ◽  
pp. 259-263 ◽  
Author(s):  
Sara J. Aberle ◽  
Benjamin J. Sandefur ◽  
Kharmene L. Sunga ◽  
Ronna L. Campbell ◽  
Christine M. Lohse ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Direct Laryngoscopy ◽  
Ease Of Use ◽  
Video Laryngoscopy ◽  
Tube Placement ◽  
Secondary Outcome ◽  
High Fidelity ◽  
Perceived Ease Of Use ◽  
Publication Type ◽  
Endotracheal Tube Placement

AbstractIntroductionManagement of contaminated patients in the decontamination corridor requires the use of hazardous material (HazMat) personal protective equipment (PPE). Previous studies have demonstrated that HazMat PPE may increase the difficulty of airway management. This study compared the efficiency of video laryngoscopy (VL) with traditional direct laryngoscopy (DL) during endotracheal intubation (ETI) while wearing HazMat PPE.MethodsPost-graduate year (PGY) 1-3 Emergency Medicine residents were randomized to VL or DL while wearing encapsulating PPE. Video laryngoscopy was performed using the GlideScope Cobalt AVL video laryngoscope. The primary outcome measure was time to successful ETI in a high-fidelity simulation mannequin. Three time points were utilized in the analysis: Time 0 (blade at lips), Time 1 (blade removed from lips after endotracheal tube placement), and Time 2 (bag valve mask [BVM] attached to endotracheal tube). Secondary outcome measures were perceived ease of use and feasibility of VL and DL ETI modalities.ResultsTwenty-one of 23 (91.3%) eligible residents participated. Mean time to ETI was 10.0 seconds (SD=5.3 seconds) in the DL group and 7.8 seconds (SD=3.0 seconds) in the VL group (P=.081). Mean times from blade insertion until BVM attachment were 17.4 seconds (SD=6.0 seconds) and 15.6 seconds (SD=4.6 seconds), respectively (P=.30). There were no unsuccessful intubation attempts. Seventeen out of 20 participants (85.0%) perceived VL to be easier to use when performing ETI in PPE. Twelve out of 20 participants (60%) perceived DL to be more feasible in an actual HazMat scenario.ConclusionThe time to successful ETI was not significantly different between VL and DL. Video laryngoscopy had a greater perceived ease of use, but DL was perceived to be more feasible for use in actual HazMat situations. These findings suggest that both DL and VL are reasonable modalities for use in HazMat situations, and the choice of modality could be based on the clinical situation and provider experience.AberleSJ, SandefurBJ, SungaKL, CampbellRL, LohseCM, Alecastro PulsH, LaudonS, SztajnkrycerMD. Intubation efficiency and perceived ease of use of video laryngoscopy vs direct laryngoscopy while wearing HazMat PPE: a preliminary high-fidelity mannequin study. Prehosp Disaster Med. 2015;30(3):1–5.

scholarly journals Modified Infant Feeding Tube as an Indigenous Endotracheal Tube in Unanticipated Congenital Subglottic Stenosis

2021 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Rahul Gupta ◽  
Rama Chatterjee ◽  
Neelam Dogra ◽  
Dinesh Kumar Barolia ◽  
Pratibha Rathore ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Infant Feeding ◽  
Feeding Tube ◽  
Subglottic Stenosis ◽  
Surgical Patients ◽  
Successful Intubation ◽  
Failed Intubation ◽  
Shunt System ◽  
Emergency Airway ◽  
Infant Feeding Tube

Introduction: In neonates with an unanticipated difficult airway, there is an increased probability of failed intubation even with highly trained hands while performing direct laryngoscopy. Aims: We describe our experience of using a modified infant feeding tube (IFT) as an indigenous endotracheal tube (ETT) in a series of paediatric surgical patients with congenital subglottic stenosis (SGS). Material and Methods: A retrospective study was performed in our institute from January 2018 to December 2019. ETT with modified 6 and 8 French (Fr) sized IFT’s were used. A stylet obtained from the VP shunt system was used to aid in intubation. Results: Out of 12,500 admissions in our department, there were 5 pediatric cases with SGS which were managed using modified IFT. Four were neonates and 1 infant (M:F = 2:3). Modified IFT(s) were used after failed intubation with ETT of size 2.5 mm in 4 patients (non-availability of ETT of size 2 mm), while in one neonate, even 2 mm ETT could not be negotiated due to SGS. In all the 5 children, successful intubation was finally performed with modified 8 French (Fr) IFT in 3, and with modified 6 Fr IFT in two cases. The surgical procedure was completed in 4 neonates out of 5 cases, while in one infant it was deferred due to the clinical condition of the patient and significant SGS. Conclusion: All 5 patients with SGS were managed without performing a tracheostomy. Modified IFT(s) is an effective alternative if smaller sized ETT(s) cannot be negotiated or unavailable in difficult neonatal and paediatric airway. This modified IFT as ETT has to be an important part of the emergency airway tray. It should not be considered as a replacement for routine use of standard ETT.

Intubating Through Supraglottic Airway Devices: A Narrative Review

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Say Yang Ong ◽  
Vanessa Moll ◽  
Berthold Moser ◽  
Amit Prabhakar ◽  
Elyse M. Cornett ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Airway Device ◽  
Narrative Review ◽  
Supraglottic Airway ◽  
Successful Intubation ◽  
Success Rates ◽  
Supraglottic Airway Device ◽  
Supraglottic Airway Devices ◽  
Consistent Performance

Implication Statement: Despite the increasing popularity of video laryngoscopes, the supraglottic airway device (SAD) remains a critical airway rescue tool. The SAD provides a conduit for tracheal intubation in failed laryngoscopy. This article aims to help the operator: (1) select an intubating SAD with consistent performance; (2) inform the appropriate SAD-endotracheal tube pairings; and (3) explain various SAD and endotracheal tube maneuvers available to increase chances of successful intubation. Objectives: The first supraglottic airway device (SAD) was introduced more than thirty years ago. Since then, SADs have undergone multiple iterations and improvements. The SAD remains an airway rescue device for ventilation and an intubation conduit on difficult airway algorithms. Data Sources: Several SADs are specifically designed to facilitate tracheal intubation, i.e., “intubating SADs,” while most are “non-intubating SADs.” The two most commonly reported tracheal intubation methods via the SADs are the blind and visualized passage of the endotracheal tube (ETT) preloaded on a fiberoptic scope. Fiberoptic guided tracheal intubation (FOI) via an intubating SAD generally has higher success rates than blind intubations and is thus preferred. However, fiberscopes might not always be readily available, and anesthesiologists should be skilled to successfully intubate blindly through a SAD. Summery: This narrative review describes intubating SAD with consistent performance, appropriate SAD-ETT pairings, and various SAD and ETT maneuvers to increase successful intubation chances.

scholarly journals Comparing Four Video Laryngoscopes and One Optical Laryngoscope with a Standard Macintosh Blade in a Simulated Trapped Car Accident Victim

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Florian J. Raimann ◽  
Daniel M. Tepperis ◽  
Dirk Meininger ◽  
Kai Zacharowski ◽  
Richard Schalk ◽  
...  
Keyword(s):  
Gold Standard ◽  
Video Laryngoscope ◽  
Video Laryngoscopy ◽  
Successful Intubation ◽  
Macintosh Blade ◽  
Intubation Success ◽  
Accident Victim ◽  
Unconscious Patients ◽  
Car Accident ◽  
Regular Training

Background. Tracheal intubation still represents the “gold standard” in securing the airway of unconscious patients in the prehospital setting. Especially in cases of restricted access to the patient, video laryngoscopy became more and more relevant. Objectives. The aim of the study was to evaluate the performance and intubation success of four different video laryngoscopes, one optical laryngoscope, and a Macintosh blade while intubating from two different positions in a mannequin trial with difficult access to the patient. Methods. A mannequin with a cervical collar was placed on the driver’s seat. Intubation was performed with six different laryngoscopes either through the driver’s window or from the backseat. Success, C/L score, time to best view (TTBV), time to intubation (TTI), and number of attempts were measured. All participants were asked to rate their favored device. Results. Forty-two physicians participated. 100% of all intubations performed from the backseat were successful. Intubation success through the driver’s window was less successful. Only with the Airtraq® optical laryngoscope, 100% success was achieved. Best visualization (window C/L 2a; backseat C/L 2a) and shortest TTBV (window 4.7 s; backseat 4.1 s) were obtained when using the D-Blade video laryngoscope, but this was not associated with a higher success through the driver’s window. Fastest TTI was achieved through the window (14.2 s) when using the C-MAC video laryngoscope and from the backseat (7.3 s) when using a Macintosh blade. Conclusions. Video laryngoscopy revealed better results in visualization but was not associated with a higher success. Success depended on the approach and familiarity with the device. We believe that video laryngoscopy is suitable for securing airways in trapped accident victims. The decision for an optimal device is complicated and should be based upon experience and regular training with the device.

GlideScope-assisted nerve integrity monitoring tube placement for intra-operative recurrent laryngeal nerve monitoring

2012 ◽  
Vol 126 (12) ◽  
pp. 1271-1273 ◽  
Author(s):  
S P Kanotra ◽  
D B Kuriloff ◽  
J Lesser ◽  
F Rest-Flarer
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Endotracheal Tube ◽  
Laryngeal Nerve ◽  
Tube Placement ◽  
Successful Intubation ◽  
Integrity Monitoring ◽  
Nerve Monitoring ◽  
Correct Placement ◽  
Glidescope Video Laryngoscope ◽  
Recurrent Laryngeal Nerve Monitoring

AbstractObjective:The proper positioning of the Nerve Integrity Monitoring® endotracheal tube during recurrent laryngeal nerve monitoring is of paramount importance. This article describes our experience with the GlideScope® and explains how it can facilitate the accurate placement of the Nerve Integrity Monitoring endotracheal tube.Methods:Endotracheal intubation with the Nerve Integrity Monitoring endotracheal tube was performed in 250 patients undergoing thyroidectomies using the GlideScope video laryngoscope. The correct positioning of the tube was determined according to impedance values of less than 5 kohm and an impedance imbalance of less than 1 kohm.Results:Successful intubation was achieved in all cases. The GlideScope aided the correct placement of the Nerve Integrity Monitoring endotracheal tube in the majority of the cases.Conclusion:The GlideScope provides an excellent means to ensure the correct positioning of the Nerve Integrity Monitoring tube. It allows both the surgeon and the anaesthesiologist to participate in the intubation process and confirm correct placement of the tube, whilst also allowing gentle intubation with improved visibility.

Endoscopic Study of Mechanisms of Failure of Endotracheal Tube Advancement into the Trachea during Awake Fiberoptic Orotracheal Intubation

2005 ◽  
Vol 102 (5) ◽  
pp. 910-914 ◽  
Author(s):  
Dana M. Johnson ◽  
Aaron M. From ◽  
Russell B. Smith ◽  
Robert P. From ◽  
Mazen A. Maktabi
Keyword(s):  
Endotracheal Tube ◽  
Nerve Block ◽  
Soft Tissues ◽  
Orotracheal Intubation ◽  
Topical Anesthesia ◽  
Successful Intubation ◽  
Flexible Bronchoscope ◽  
Endoscopic Study ◽  
The Right ◽  
Relevant Factors

Background Advancing the endotracheal tube (ETT) over a flexible bronchoscope (FB) during awake fiberoptic orotracheal intubation is often impeded. The goal of this study was to identify the sites and mechanisms that inhibit the passing of the ETT into the trachea. Methods Forty-five consenting patients underwent a clinically indicated awake fiberoptic orotracheal intubation. After topical anesthesia, nerve block, or both, an awake fiberoptic orotracheal intubation was performed. The placement of the FB and advancement of the ETT over the FB were videotaped using a second nasally inserted FB. An otolaryngologist later reviewed the videotaped data. Results The right arytenoid or the interarytenoid soft tissues inhibited advancement of the ETT in 42 and 11% of all patients, respectively. In all cases in which the FB was located on the right side of the larynx, failure of ETT advancement almost always occurred at the right arytenoid. Withdrawing the ETT and rotating it 90 degrees counterclockwise resulted in successful intubation on the second, third, and fourth attempts in 26.6, 20, and 0.7% of patients, respectively. Conclusion The right arytenoid frequently inhibits advancement of the ETT over the FB into the trachea during awake fiberoptic orotracheal intubation. The FB position in the larynx before tube advancement and the orientation of the ETT are relevant factors in failure of advancement of the ETT into the trachea. The authors recommend positioning the FB in the center of the larynx and orienting the bevel of the ETT to face posteriorly during the first attempt at intubation.

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