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Aims and objectivesChronic cough is an important condition with significant morbidity. Speech therapy has been recognised as a treatment option. The aim of this study was to review procedure outcomes from laryngoscopy and to review the utility of this procedure in a chronic cough cohort. Speech and Language Therapists (SLTs) conduct diagnostic provocation laryngoscopy as part of routine care for upper airway disorders (RCSLT 2021).MethodsMedical records were reviewed over 12 months in patients who had been seen in a chronic cough service. Demographics and assessment outcomes were collated for patients who had a diagnostic laryngoscopy.Results49 patients underwent a diagnostic laryngoscopy (of whom 76% female, mean age 59.8, SD = 15.37). For procedure outcomes, see table 1. Six patients were discharged. Referrals for Physiotherapy were for assessment of breathing pattern disorder. Of those commenced on sinus treatment, five (50%) had described symptoms of nasal congestion or postnasal drip at initial consultation. Of those diagnosed with ILO, five (45.5%) did not report any breathlessness at initial consultation. No adverse events occurred in laryngoscopy.Abstract P108 Table 1ConclusionThe benefits of laryngoscopy include: Confirmation of upper airway diagnoses and comorbidities, informing onward referrals and medical treatment, trialling and identifying beneficial therapy techniques for speech and language intervention. Images can also be reviewed for comparison at later date, to give reassurance to the patient and for bio visual feedback.

In this randomized trial, the use of video laryngoscopy in critically ill patients undergoing intubation in the ED or ICU resulted in a higher incidence of successful intubation on the first attempt than direct laryngoscopy.

Background Tracheal intubation is a core skill in airway management for anesthesiologists as well as for other medical professionals involved in advanced airway procedures. Traditionally, tracheal intubation in hospitals has been performed using a Macintosh blade for direct laryngoscopy (DL). However, recent literature increasingly supports the potential benefits of routine video laryngoscopy (VL). The aim of this study was to assess whether primary training in hyperangulated VL improves the first-pass success rate of tracheal intubation among first-year anesthesiology residents, compared to conventional DL training, in the operating room. Methods The JuniorDoc-VL Trial is a randomized, controlled, patient-blinded clinical trial of novice anesthesiology residents trained in DL and VL. Thirty residents will be randomly assigned to either the intervention group (VL group) or the control group (DL group) with a 1:1 allocation. The first-pass-success (FPS) rates (primary endpoint) and complication rates (secondary endpoint) will be compared between groups. Discussion We hypothesize that the primary use of hyperangulated video laryngoscopy (VL) in the experimental group will increase first-pass-success rates among inexperienced residents and reduce complication rates associated with advanced airway management in a mixed patient population. This study may provide an opportunity to develop strategies that allow physicians not routinely involved in anesthesia to effectively learn and maintain their skills in tracheal intubation. Trial registration ClinicalTrials.gov Registry (NCT06360328). Registered on 09.04.2024.

Intubation in neonates is challenging, and repeated attempts are associated with adverse events. Among neonates undergoing urgent intubation, video laryngoscopy resulted in more successful first attempts than direct laryngoscopy.

To compare three different video laryngoscope devices (VL) to standard direct laryngoscopy (DL) for tracheal intubation of obese patients undergoing bariatric surgery. Hypothesis: VL (vs DL) would reduce the time required to achieve successful tracheal intubation and improve the glottic view. Prospective, randomized and controlled. Preoperative/operating rooms and postanesthesia care unit. One hundred twenty-one obese patients (ASA physical status I-III), aged 18 to 80 years, body mass index (BMI) >30 kg/m2 undergoing elective bariatric surgery. Patients were prospectively randomized assigned to one of 4 different airway devices for tracheal intubation: standard Macintosh (Mac) blade (DL); Video-Mac VL; Glide Scope VL; or McGrath VL. After performing a preoperative airway evaluation, patients underwent a standardized induction sequence. The glottic view was graded using the Cormack Lehane and percentage of glottic opening (POGO) scoring systems at the time of tracheal intubation. Times from the blade entering the patient’s mouth to obtaining a glottic view, placement of the tracheal tube, and confirmation of an end-tidal CO2 waveform were recorded. In addition, intubation attempts, adjuvant airway devices, hemodynamic changes, adverse events, and any airway-related trauma were recorded. All three VL devices provided improved glottic views compared to standard DL (p < 0.05). Video-Mac VL and McGrath also significantly reduced the time required to obtain the glottic view. Video-Mac VL significantly reduced the time required for successful placement of the tracheal tube (vs DL and the others VL device groups). The Video-Mac and GlideScope required fewer intubation attempts (P< .05) and less frequent use of ancillary intubating devices compared to DL and the McGrath VL. Video-Mac and GlideScope required fewer intubation attempts than standard DL and the McGrath device. The Video-Mac also significantly reduced the time needed to secure the airway and improved the glottic view compared to standard DL. •Prospective and randomized study•Comparing 3 video laryngoscope devices to standard direct laryngoscopy•For tracheal intubation of obese patients undergoing elective bariatric surgery•The use of VL reduced the time required to achieve successful tracheal intubation and improved the glottic view of an obese surgical population

ObjectivesNeonatal intubation is a difficult skill to learn and teach. If an attempt is unsuccessful, the intubator and instructor often cannot explain why. This study aims to review videolaryngoscopy recordings of unsuccessful intubations and explain the reasons why attempts were not successful.Study designThis is a descriptive study examining videolaryngoscopy recordings obtained from a randomised controlled trial that evaluated if neonatal intubation success rates of inexperienced trainees were superior if they used a videolaryngoscope compared with a laryngoscope. All recorded unsuccessful intubations were included and reviewed independently by two reviewers blinded to study group. Their assessment was correlated with the intubator’s perception as reported in a postintubation questionnaire. The Cormack-Lehane classification system was used for objective assessment of laryngeal view.ResultsRecordings and questionnaires from 45 unsuccessful intubations were included (15 intervention and 30 control). The most common reasons for an unsuccessful attempt were oesophageal intubation and failure to recognise the anatomy. In 36 (80%) of intubations, an intubatable view was achieved but was then either lost, not recognised or there was an apparent inability to correctly direct the endotracheal tube. Suctioning was commonly performed but rarely improved the view.ConclusionsLack of intubation success was most commonly due to failure to recognise midline anatomical structures. Trainees need to be taught to recognise the uvula and epiglottis and use these landmarks to guide intubation. Excessive secretions are rarely a factor in elective and premedicated intubations, and routine suctioning should be discouraged. Better blade design may make it easier to direct the tube through the vocal cords.

Purpose Channelled blades have the advantage of avoiding stylet use and potential airway injury during videolaryngoscopic intubation. Nevertheless, the effectiveness of channelled Macintosh-type blades has not yet been fully established. We sought to assess the utility of channelled Macintosh-type blades for videolaryngoscopic intubation under cervical spine immobilization. Methods We conducted a randomized controlled noninferiority trial in neurosurgical patients with a difficult airway simulated by a cervical collar. Videolaryngoscopic intubation with a reinforced tracheal tube was performed using a channelled Macintosh-type blade without a stylet (channelled group, n  = 130) or a nonchannelled Macintosh-type blade with a stylet (nonchannelled group, n  = 131). The primary outcome was intubation success rate. Secondary outcomes included time to intubation and incidence or severity of intubation-related complications (subglottic, lingual, and dental injuries; bleeding; sore throat; and hoarseness). Results The initial intubation success rate was 98% and 99% in the channelled and nonchannelled groups, respectively, showing the noninferiority of the channelled group (difference in proportions −0.8%; 95% confidence interval [CI], −4.8% to 2.9%; predefined noninferiority margin, −5%; P  = 0.62). Fewer participants in the channelled group had subglottic injuries than in the nonchannelled group (32% [32/100] vs 57% [54/95]; difference in proportions, −25%; 95% CI, −39% to −11%; P  < 0.001). There were no significant differences between the two groups in the overall intubation success rate, time to intubation, and incidence or severity of other intubation-related complications. Conclusions For videolaryngoscopic intubation in patients with a cervical collar, channelled Macintosh-type blades are an alternative to nonchannelled Macintosh-type blades, with a noninferior initial intubation success rate and a lower incidence of subglottic injury. Study registration CRIS.nih.go.kr ( KCT0005186 ); first submitted 29 June 2020.

Background Direct laryngoscopy (DL) is widely recognized as the most commonly used method for tracheal intubation. However, growing evidence highlights the increasingly prominent role of video laryngoscopy (VL) in the management of difficult airways. This study aimed to determine the most effective medical education method to equip medical students with this critical skill. In addition to evaluating the contributions of an intubation training program utilizing direct laryngoscopy and video laryngoscopy to tracheal intubation success among inexperienced medical students, we also aimed to explore the potential benefits of combining these two techniques. Methods This mannequin-based study included 130 medical students. Before the study began, participants attended a 30-minute theoretical training session. Participants were randomly assigned to start with one of two scenarios. In each scenario, participants were given three attempts to perform intubation using each laryngoscope. The maximum allowable time for each intubation was set at 3 min. Students who successfully intubated within 3 min were recorded as successful, while those who failed to do so were recorded as unsuccessful. Results The study demonstrated that VL provided higher success rates and shorter intubation times, particularly during the first and second attempts. However, it is noteworthy that no significant difference in success rates was observed between VL and DL during the third attempt. Conclusion This study highlights the necessity of integrating both VL and DL methods in intubation training programs. The combination of both approaches allows students to achieve quick initial results while progressively developing proficiency for more complex scenarios over time. Clinical trial number Not applicable.

Background Video laryngoscopes are widely used for tracheal intubation, particularly in challenging airway scenarios. The McGrath MAC, AIRWAY SCOPE ® , and AceScope ® are popular video laryngoscopes with different design features. This study aimed to compare the effectiveness and usability of these three devices in novice healthcare providers during simulated tracheal intubation scenarios employing a manikin. Methods Sixty novice healthcare providers, including nurses and pharmacists, were enrolled in this randomized crossover study. Participants performed tracheal intubation using the McGrath MAC, AIRWAY SCOPE, and AceScope in both normal airway and cervical spine immobilization models. Primary outcomes were intubation success rate and time to intubation. Secondary outcomes included user preferences, device ease of use, and the incidence of dental injuries. Results The AIRWAY SCOPE demonstrated the shortest intubation time in both normal airway and cervical spine immobilization models (14.90 ± 1.76 s and 23.80 ± 2.43 s, respectively), followed by the McGrath MAC and AceScope. All devices exhibited high success rates, and there were no significant differences in perceived difficulty among the three video laryngoscopes. The incidence of dental injuries was generally comparable among the devices. However, in the cervical spine immobilization model, the AceScope demonstrated a significantly higher rate of dental injuries compared to the McGrath MAC ( p  < 0.05), highlighting a potential concern for clinical practice. Conclusions The AIRWAY SCOPE was the most efficient video laryngoscope in terms of intubation time, followed by the McGrath MAC and AceScope. However, all devices showed high success rates and no significant differences in perceived difficulty. Further research is needed to validate these findings in clinical settings and investigate the impact of device-specific features on intubation outcomes and dental injury incidence. Trial registration Registration number: jRCT1030240598 ( https://jrct.niph.go.jp/re/reports/detail/91422 ) The registration date of the clinical trial is January 8, 2025.UMIN000050394.