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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.

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.

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.

Excessive force during laryngoscopy for endotracheal intubation can result in injury to airway soft tissues and hemodynamic stress responses. In this randomized controlled trial on simulated intubation, we aimed to evaluate the effect of bed height on laryngoscopy force and operator ergonomics. This study was registered on Clinical Research Information Service (CRIS) registry (KCT0006948). Fifty operators with varying levels of experience were enrolled to intubate an airway mannequin at two different bed heights- anterior superior iliac spine (level A) and xyphoid process (level X) of each operator-in a randomized sequence. The laryngoscopy force measured with a Pliance® pressure sensor attached to the surface of the Macintosh laryngoscopy blade, intubation characteristics, and ergonomic score based on the Rapid Entire Body Assessment tool were compared between the two bed heights (level A vs. X). Peak and impulse laryngoscopy forces were significantly lower at xyphoid (level X) compared to the lower bed height (level A) (peak force: 36.06 ± 9.77 N vs. 33.74 ± 8.69 N, P = 0.049; impulse force: 251.82 ± 106.06 N vs. 224.18 ± 86.48, P = 0.005). Laryngeal view (Cormack-Lehane grade) and subjective comfort were also better at level X (P = 0.0024 and P < 0.001, respectively). The ergonomic score was higher at the lower bed height (level A, P < 0.001), indicating a more strenuous work posture. Bed height at xyphoid level reduced laryngoscopy force while improving laryngeal view and ergonomic comfort compared to ASIS level. Adjusting the bed height before endotracheal intubation can improve the operating environment, which in turn may contribute to safety of both patient and operator.

This study aimed to compare the efficacy and utility of the McGrath™ videolaryngoscope, using the Macintosh-like McGrath™ MAC blade and the hyperangulated McGrath™ MAC Xblade with a conventional Macintosh blade under simulated resuscitation conditions. A prospective, randomized study under conditions mimicking ongoing chest compressions was conducted with 90 anesthesiologists. Intubation success rates, time-to-vocal cords, time-to-intubate, and time-to-ventilate were measured. Additionally, the study assessed the subjective ratings and the perceived workload using the 'NASA-task-load-index' during the procedure. The overall intubation success rate was device dependent 99-100%. The McGrath™ MAC and McGrath™ MAC Xblade showed faster visualization times compared to conventional blades. The MAC blade demonstrated superior performance in time-to-intubate and time-to-ventilate compared to both conventional and MAC Xblades. Despite excellent visualization, the MAC Xblade posed challenges in tube placement, reflected in a prolonged intubation time of >120 seconds in one case. Both MAC and MAC Xblade reduced potential dental injuries and interruptions to chest compressions compared to conventional laryngoscopes. User experience significantly impacted intubation times with conventional laryngoscopes, but this effect was mitigated with videolaryngoscopy. Participants reported lower stress and effort when using videolaryngoscopes, with the MAC blade rated superior in perceived time pressure. The study supports the superiority of videolaryngoscopy with a Macintosh-like blade over conventional laryngoscopy during mechanical chest compressions, particularly for less experienced users. The McGrath™ MAC blade, in particular, offers advantages in intubation time, user-friendliness, and reduced stress. However, the MAC Xblade's challenges during tube placement highlight the need for further clinical validation. Continued research is essential to refine guidelines and improve resuscitation outcomes.

Visual laryngoscope, as the most commonly used tracheal intubation tool in clinical practice, has a high intubation success rate and is quick to learn, but there are risks of over flexion of the neck, tooth loss, etc. The visual stylet helps to make up for these shortcomings. This study aimed to compare the effects of the visual stylet and visual laryngoscope on transoral single lumen tracheal intubation in non-difficult airways. The primary outcome was intubation time, and secondary outcomes included glottic exposure time, first success rates, hemodynamic indices, intubation-related complications. A total of 148 patients were included, with 75 in the visual stylet (VS) group and 73 in the visual laryngoscope (VL) group. The intubation time in the VS group was 35 (11) seconds, significantly shorter than the 41 (9) seconds in the VL group ( P  < 0.001). Immediately post-intubation, the MAP in the VS group was 80 (20.5) mmHg, lower than 87 (23) mmHg in the VL group ( P  < 0.01). Intubation-related complications are also lower in VS group compared to VL group. Other outcomes don’t have significant difference. Our study has demonstrated that the visual stylet significantly reduces intubation time and provides more stable hemodynamics. For patients with limited mouth opening, shorter thyromental distance, or higher Cormack-Lehane grades, the visual stylet may potentially be a better choice compared to video laryngoscopy for tracheal intubation. Trial registration China Clinical Trial Registry (ChiCTR2100051812) (05/10/2021).

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 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.

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.

In modern times, the emergency physician (EP) has access to a host of video laryngoscopes (VL). There are different makes, models, angulations in the blades provided by different VLs. The blades may be channeled or non-channeled. In busy emergency departments (ED), ease and speed of intubations in managing the emergent airways may impact the outcome for the patient. The primary objective of our study was to compare the rates of first pass success using the channeled versus the non-channeled blades of the KingVision VL (KVVL). This was a randomized controlled single blinded study. All patients requiring emergent definitive airway management were included in the study. They were randomized into 2 groups – channeled and non-channeled KVVL. Intubations were carried out accordingly. First pass success, time taken to intubate and crossover between the blades were recorded. A total of 130 patients were enrolled in the study. First pass success for the channeled and non-channeled KVVL was 55.4 % and 81.6 % (p = 0.005) respectively. The mean time to intubate using the channeled and non-channeled KVVL were 24.69 s [95 % CI 20.25–29.13] and 28.95 s [95 % CI 23.64–34.26] (p = 0.207) respectively. A total of 33.07 % patients had crossovers between the blades. We found the non-channeled blades to have a significantly higher percentage of first pass success. Performance with respect to time to intubate was similar between the two. We recommend using the non-channeled KVVL for intubations in the EDs.