Can video laryngoscopy and supplemental oxygen redefine pediatric, infant and neonatal tracheal intubation standards?
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ABSTRACT:
SUBMITTER: Coelho LP
PROVIDER: S-EPMC10998985 | biostudies-literature | 2024 Mar
REPOSITORIES: biostudies-literature
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Can video laryngoscopy and supplemental oxygen redefine pediatric, infant and neonatal tracheal intubation standards?
Coelho Laila Pinto LP Couto Thomaz Bittencourt TB
Translational pediatrics 20240322 3
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Project description:BackgroundRecent trials showed that video laryngoscopy (VL) did not yield higher first-attempt tracheal intubation success rate than direct laryngoscopy (DL) and was associated with higher rates of complications. Tracheal intubation can be more challenging in the general ward than in the intensive care unit. This study aimed to investigate which laryngoscopy mode is associated with higher first-attempt intubation success in a general ward.MethodsThis is a retrospective study of tracheal intubations conducted at a tertiary academic hospital. This analysis included all intubations performed by the medical emergency team in the general ward during a 48-month period.ResultsFor the 958 included patients, the initial laryngoscopy mode was video laryngoscopy in 493 (52%) and direct laryngoscopy in 465 patients (48%). The overall first-attempt success rate was 69% (664 patients). The first-attempt success rate was higher with VL (79%; 391/493) than with DL (59%; 273/465, p < 0.001). The first-attempt intubation success rate was higher among experienced operators (83%; 266/319) than among inexperienced operators (62%; 398/639, p < 0.001). In multivariate logistic regression analyses, VL, pre-intubation heart rate, pre-intubation SpO2 > 80%, a non-predicted difficult airway, experienced operator, and Cormack-Lehane grade were associated with first-attempt intubation success in the general ward. Over all intubation-related complications were not different between two groups (27% for VL vs. 25% for DL). However, incidence of a post-intubation SpO2 < 80% was higher with VL than with DL (4% vs. 1%, p = 0.005), and in-hospital mortality was also higher (53.8% vs. 43%, p = 0.001).ConclusionIn a general ward setting, the first-attempt intubation success rate was higher with video laryngoscopy than with direct laryngoscopy. However, video laryngoscopy did not reduce intubation-related complications. Furthers trials on best way to perform intubation in the emergency settings are required.
| S-EPMC6089856 | biostudies-literature
Project description:This observational study aimed to compare the glottic view between video and direct laryngoscopy for tracheal intubation in the surgical position for thyroid surgery with intraoperative neuromonitoring. Patients scheduled for elective thyroid surgery with intraoperative neuromonitoring were enrolled. After the induction of anesthesia, patients were positioned in the thyroid surgical posture with a standard inclined pillow under their head and back. An investigator assessed the glottic view using the percentage of glottic opening (POGO) scale and the modified Cormack-Lehane grade in direct laryngoscopy and then video laryngoscopy sequentially while using the same McGRATH™ MAC video laryngoscope at once, with or without external laryngeal manipulation, at the surgical position. A total of thirty-nine patients were participated in this study. Without external laryngeal manipulation, the POGO scale significantly improved during video laryngoscopy compared to direct laryngoscopy in the thyroid surgical position (60.0 ± 38.2% vs. 22.4 ± 23.8%; mean difference (MD) 37.6%, 95% confidence interval (CI) = [29.1, 46.0], P < 0.001). Additionally, with external laryngeal manipulation, the POGO scale showed a significant improvement during video laryngoscopy compared to direct laryngoscopy (84.6 ± 22.9% vs. 58.0 ± 36.3%; MD 26.7%, 95% CI = [18.4, 35.0] (P < 0.001). The superiority of video laryngoscopy was also observed for the modified Cormack-Lehane grade. In conclusion, video laryngoscopy with the McGRATH™ MAC video laryngoscope, when compared to direct laryngoscopy with it, improved the glottic view during tracheal intubation in the thyroid surgical position. This enhancement may potentially facilitate the proper placement of the electromyography tracheal tube and prevent tube displacement due to positional change for thyroid surgery.
| S-EPMC10904775 | biostudies-literature
Project description:BackgroundThe high incidence of airway management failure in the emergency department (ED) necessitates a comparative analysis of laryngoscopy methods. This study aims to compare the success and complications associated with video-assisted laryngoscopy (VL) and direct laryngoscopy (DL) in emergency tracheal intubation in ED.MethodsThis retrospective cohort study was conducted at the ED of Thammasat University Hospital. It involved adult patients undergoing emergency tracheal intubation using either VL (GlideScope®) or DL (Macintosh®). The outcomes assessed were success rates of intubation and occurrence of peri-intubation adverse events. Propensity score matching and multivariable risk regression analysis were employed for statistical evaluation.ResultsThe study included 3,424 patients, with 342 in the VL group and 3,082 in the DL group. The initial analysis revealed no significant differences in the intubation success rates between the two methods. However, the VL group experienced fewer peri-intubation adverse events (33% compared to 40%). After propensity score matching, a higher first-attempt success rate was observed in the DL group (88.9% vs. 81.3%, risk difference: 7.6, 95% CI: 1.9 to 13.2, p=0.009), but there was no statistically significant difference in peri-intubation adverse events. VL had a lower first-attempt success rate among low-experience intubators. Subgroup analyses of intubators with moderate and high experience, as well as patients who received both induction agents and neuromuscular blocking agents, show results consistent with the analysis of the entire cohort.ConclusionBoth VL and DL have comparable first-attempt success rates and peri-intubation adverse events. VL is particularly beneficial when used by moderately or highly experienced intubator. The choice of intubation method, combined with clinical experience and technique plays a critical role in the success and safety of emergency intubations.
| S-EPMC11577915 | biostudies-literature
Project description:BackgroundTracheal intubation remains the gold standard of airway management in emergency medicine and maximizing safety, intubation success, and especially first-pass intubation success (FPS) in these situations is imperative.MethodsWe conducted a prospective observational study on all 12 helicopter emergency medical service (HEMS) bases of the Swiss Air Rescue, between February 15, 2018, and February 14, 2019. All 428 patients on whom out-of-hospital advanced airway management was performed by the HEMS crew were included. The C-MAC video laryngoscope was used as the primary device for tracheal intubation. Intubation procedures were recorded by the video laryngoscope and precise time points were recorded to verify the time necessary for each attempt and the overall procedure time until successful intubation. The videos were further analysed for problems and complications during airway management by an independent reviewer. Additionally, a questionnaire about the intubation procedure, basic characteristics of the patient, circumstances, environmental factors, and the provider's level of experience in airway management was filled out. Main outcome measures were FPS of tracheal intubation, overall success rate, overall intubation time, problems and complications of video laryngoscopy.ResultsFPS rate was 87.6% and overall success rate 98.6%. Success rates, overall time to intubation, and subjective difficulty were not associated to the providers' expertise in airway management. In patients undergoing CPR FPS was 84.8%, in trauma patients 86.4% and in non-trauma patients 93.3%. FPS in patients with difficult airway characteristics, facial trauma/burns or obesity ranges between 87 and 89%. Performing airway management indoors or inside an ambulance resulted in a significantly higher FPS of 91.1% compared to outdoor locations (p < 0.001). Direct solar irradiation on the screen, fogging of the lens, and blood on the camera significantly impaired FPS. Several issues for further improvements in the use of video laryngoscopy in the out-of-hospital setting and for quality control in airway management were identified.ConclusionAirway management using the C-MAC video laryngoscope with Macintosh blade in a group of operators with mixed experience showed high FPS and overall rates of intubation success. Video recording emergency intubations may improve education and quality control.
| S-EPMC7968290 | biostudies-literature
Project description:We aimed to analyze the effect of video laryngoscopy on intubation success, time to intubation, and adverse events in infants and neonates. A systematic review and meta-analysis was performed, for which a neonates (age less than 29 days) and infants (age less than 365 days) needing to be intubated were included. The main outcomes were first attempt success rate in the intubation, time to intubation, and adverse events. Evidence certainty was assessed according to GRADE. We included 13 studies. Seven studies with 897 patients focused on neonates, and the first attempt success rate was higher in the video laryngoscopy group (RR 1.18, CI: 1.03-1.36). Six studies included 1039 infants, and the success rate was higher in the video laryngoscopy group (RR 1.06, CI: 1.00-1.20). Time to intubation was assessed in 11 trials, and there was no difference between the groups (mean difference 1.2 s, CI - 2.2 s to + 4.6 s). Odds of desaturation (OR 0.62, CI 0.42-0.93) and nasal/oral trauma (OR 0.24, CI 0.07-0.85) were lower in the video laryngoscopy group. Evidence certainties varied between moderate and low.ConclusionWe found moderate certainty evidence that the use of video laryngoscopy improves first attempt success rates in neonate and infant intubations, while the time to intubation did not differ between video and direct laryngoscopy groups. Further studies are still needed to improve the first intubation success rates in neonates.What is known• Video laryngoscopy has been shown to improve first-pass intubation success rates and reduce time to intubation in adults and older children.What is new• Video laryngoscopy improved the first attempt intubation success rates both in neonates and in infants. • Video laryngoscopy did not increase the time to intubation, and it was associated with less adverse events than direct laryngoscopy.
| S-EPMC11579204 | biostudies-literature
Project description: Not available
| S-EPMC8978307 | biostudies-literature
Project description:BackgroundEstablishment of a secure airway is a critical part of neonatal resuscitation in the delivery room and the neonatal unit. Videolaryngoscopy has the potential to facilitate successful endotracheal intubation and decrease adverse consequences of delay in airway stabilization. Videolaryngoscopy may enhance visualization of the glottis and intubation success in neonates.ObjectivesTo determine the efficacy and safety of videolaryngoscopy compared to direct laryngoscopy in decreasing the time and attempts required for endotracheal intubation and increasing the success rate at first intubation in neonates.Search methodsWe used the search strategy of Cochrane Neonatal. In May 2017, we searched for randomized controlled trials (RCT) evaluating videolaryngoscopy for neonatal endotracheal intubation in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, abstracts of the Pediatric Academic Societies, websites for registered trials at www.clinicaltrials.gov and www.controlled-trials.com, and reference lists of relevant studies.Selection criteriaRCTs or quasi-RCTs in neonates evaluating videolaryngoscopy for endotracheal intubation compared with direct laryngoscopy.Data collection and analysisReview authors performed data collection and analysis as recommended by Cochrane Neonatal. Two review authors independently assessed studies identified by the search strategy for inclusion.We used the GRADE approach to assess the quality of evidence.Main resultsThe search yielded 7057 references of which we identified three RCTs for inclusion, four ongoing trials and one study awaiting classification. All three included RCTs compared videolaryngoscopy with direct laryngoscopy during intubation attempts by trainees.Time to intubation was similar between videolaryngoscopy and direct laryngoscopy (mean difference (MD) -0.62, 95% confidence interval (CI) -6.50 to 5.26; 2 studies; 311 intubations) (very low quality evidence). Videolaryngoscopy did not decrease the number of intubation attempts (MD -0.05, 95% CI -0.18 to 0.07; 2 studies; 427 intubations) (very low quality evidence). Moderate quality evidence suggested that videolaryngoscopy increased the success of intubation at first attempt (typical risk ratio (RR) 1.44, 95% CI 1.20 to 1.73; typical risk difference (RD) 0.19, 95% CI 0.10 to 0.28; number needed to treat for an additional beneficial outcome (NNTB) 5, 95% CI 4 to 10; 3 studies; 467 intubation attempts).Desaturation episodes during intubation attempts were similar between videolaryngoscopy and direct laryngoscopy (MD -0.76, 95% CI -5.74 to 4.23; 2 studies; 359 intubations) (low quality evidence). There was no difference in the incidence of airway trauma due to intubation attempts (RR 0.10, 95% CI 0.01 to 1.80; RD -0.04, 95% CI -0.09 to -0.00; 1 study; 213 intubations) (low quality evidence).There were no data available on other adverse effects of videolaryngoscopy.Authors' conclusionsModerate to very low quality evidence suggests that videolaryngoscopy increases the success of intubation in the first attempt but does not decrease the time to intubation or the number of attempts for intubation. However, these studies were conducted with trainees performing the intubations and these results highlight the potential usefulness of the videolaryngoscopy as a teaching tool. Well-designed, adequately powered RCTs are necessary to confirm efficacy and address safety and cost-effectiveness of videolaryngoscopy for endotracheal intubation in neonates by trainees and those proficient in direct laryngoscopy.
| S-EPMC6513507 | biostudies-literature
Project description: Not available
| S-EPMC6472630 | biostudies-literature
Project description: Not available
| S-EPMC4475241 | biostudies-literature
Project description:BackgroundThe rigid tube for laryngoscopy is an instrument used in ENT, for inspecting the larynx and its vicinity. We used it to facilitate intubation, in ENT patients.MethodsTwenty patients attending for surgery were included for study. Group 1 (n=10) had no airway pathology but at least two predictors of an anatomically difficult airway. Group 2 (n=10) had an obstructing airway pathology. After anesthesia induction, classical laryngoscopy was performed, and intubation grade registered. Using the retromolar approach the rigid tube advanced slowly, the epiglottis was lifted, and the vocal cords were visualized. The bougie was introduced through the rigid tube into the trachea, the rigid tube was extracted, and the intubating tube was placed in the trachea, over the bougie.ResultsThe mean (SD) maneuver duration was 59.4 (18.2) sec. The Cormack-Lehane view of the glottis at classical laryngoscopy was poor in four patients in Group 1 and six patients in Group 2. The lowest desaturation was 82%. No complications other than sore throat were noted.ConclusionThe rigid tube for laryngoscopy is a useful tool for intubation in ENT patients. We noticed an advantage against classical intubation in patients with base of tongue carcinoma, reduced mouth opening and protruding upper incisors with this instrument.
| S-EPMC6395053 | biostudies-literature