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Using King Vision video laryngoscope with a channeled blade prolongs time for tracheal intubation in different training levels, compared to non-channeled blade.

ABSTRACT: It is generally accepted that using a video laryngoscope is associated with an improved visualization of the glottis. However, correctly placing the endotracheal tube might be challenging. Channeled video laryngoscopic blades have an endotracheal tube already pre-loaded, allowing to advance the tube once the glottis is visualized. We hypothesized that use of a channel blade with pre-loaded endotracheal tube results in a faster intubation, compared to a curved Macintosh blade video laryngoscope.After ethical approval and informed consent, patients were randomized to receive endotracheal Intubation with either the King Vision® video laryngoscope with curved blade (control) or channeled blade (channeled). Success rate, evaluation of the glottis view (percentage of glottic opening (POGO), Cormack&Lehane (C&L)) and intubating time were evaluated.Over a two-month period, a total of 46 patients (control n = 23; channeled n = 23) were examined. The first attempt success rates were comparable between groups (control 100% (23/23) vs. channeled 96% (22/23); p = 0.31). Overall intubation time was significantly shorter with control (median 40 sec; IQR [24-58]), compared to channeled (59 sec [40-74]; p = 0.03). There were no differences in glottis visualization between groups.Compared with the King Vision channeled blade, time for tracheal intubation was shorter with the control group using a non-channeled blade. First attempt success and visualization of the glottis were comparable. These data do not support the hypothesis that a channeled blade is superior to a curved video laryngoscopic blade without tube guidance.ClinicalTrials.gov NCT02344030.

SUBMITTER: Kriege M

PROVIDER: S-EPMC5578637 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Using King Vision video laryngoscope with a channeled blade prolongs time for tracheal intubation in different training levels, compared to non-channeled blade.

Kriege Marc M Alflen Christian C Noppens Ruediger R RR

PloS one 20170831 8

<h4>Purpose</h4>It is generally accepted that using a video laryngoscope is associated with an improved visualization of the glottis. However, correctly placing the endotracheal tube might be challenging. Channeled video laryngoscopic blades have an endotracheal tube already pre-loaded, allowing to advance the tube once the glottis is visualized. We hypothesized that use of a channel blade with pre-loaded endotracheal tube results in a faster intubation, compared to a curved Macintosh blade vide ...[more]

PMID: 28859114

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Project description:BACKGROUND:King Vision and McGrath MAC video laryngoscopes (VLs) are increasingly used. The purpose of this study was to evaluate the performance of nasotracheal intubation in patients with predicted difficult intubations using non-channeled King Vision VL, McGrath MAC VL or Macintosh laryngoscope by experienced intubators. METHODS:Ninety nine ASA I or II adult patients, scheduled for oral maxillofacial surgeries with El-Ganzouri risk index 1-7 were enrolled. Patients were randomly allocated to intubate with one of three laryngoscopes (non-channeled King Vision, McGrath MAC and Macintosh). The intubators were experienced with more than 100 successful nasotracheal intubations using each device. The primary outcome was intubation time. The secondary outcomes included first success rate, time required for viewing the glottis, Cormack-Lehane grade of glottis view, the number of assist maneuvers, hemodynamic responses, the subjective evaluating of sensations of performances and associated complications. RESULTS:The intubation time of King Vision and McGrath group was comparable (37.6?±?7.3?s vs. 35.4?±?8.8?s) and both were shorter than Macintosh group (46.8?±?10.4?s, p?<?0.001). Both King Vision and McGrath groups had a 100% first attempt success rate, significantly higher than Macintosh group (85%, p?<?0.05). The laryngoscopy time was comparable between King Vision and McGrath group (16.7?±?5.5?s vs. 15.6?±?6.3?s) and was shorter than Macintosh group (22.8?±?7.2?s, p?<?0.05) also. Compared with Macintosh laryngoscope, Glottis view was obviously improved when exposed with either non-channeled King Vision or McGrath MAC VL (p?<?0.001), and assist maneuvers required were reduced (p?<?0.001). The maximum fluctuations of MAP were significantly attenuated in VL groups (47.7?±?12.5?mmHg and 45.1?±?10.3?mmHg vs. 54.9?±?10.2?mmHg, p?<?0.05 and p?<?0.01). Most device insertions were graded as excellent in McGrath group, followed by Macintosh and King Vision group (p?=?0.0014). The tube advancements were easier in VLs compared with the Macintosh laryngoscope (p?<?0.001). Sore throat was found more frequent in Macintosh group compared with King Vision group (p?<?0.05). CONCLUSIONS:Non-channeled King Vision and McGrath MAC VLs were comparable and both devices facilitated nasotracheal intubation in managing predicted difficult intubations compared with Macintosh laryngoscope. TRIAL REGISTRATION:ClinicalTrials registration number NCT03126344 . Registered on April 24, 2017.

Project description:The aim of the present study was to evaluate whether the TruView video laryngoscope (TruView) facilitates pediatric endotracheal intubation (ETI) more quickly and safely than conventional Macintosh laryngoscope (MAC) in three manikin-based airway scenarios. This was a randomized crossover manikin study including 120 novice paramedics. The participants performed tracheal intubations using both TruView and MAC on a pediatric manikin in a control scenario (A), chest compression scenario (B), and chest compression cervical stabilization scenario (C). The sequence of scenarios was randomized. The primary outcome was time to intubation. Secondary outcomes were overall success rates, incidence of dental trauma, and ease of intubation. All intubation attempts were assessed by a trained assistant. The overall success rate was significantly higher with the TruView compared than the MAC in scenario B (100 vs. 81.7 %; p?=?0.011) and scenario C (100 vs. 68.3 %; p?<?0.001). The intubation time was significantly lower with the TruView than the MAC (18.5 vs. 24.3 s, p?=?0.017, for scenario A; 21.6 vs. 25.7 s, p?=?0.023, for scenario B; and 28.9 vs. 45.4 s, p?<?0.001, for scenario C). Glottic view quality was better with TruView than the MAC in all scenarios, p?<?0.001.The TruView offers better intubation conditions than the MAC on a pediatric manikin in the control scenario, chest compression scenario, and chest compression scenario with cervical stabilization scenario. The TruView may be used to elevate the epiglottis for orotracheal intubation. Further clinical studies are necessary to confirm these initial positive findings.clinicaltrials.gov Identifier: NCT02289872.•Prehospital pediatric intubation using a standard laryngoscope is varied and ranges from 63.4 to 82 %. What is New: •This is the first study showing efficiency of pediatric endotracheal intubation using the TruView PCD by paramedics in tree simulation scenarios. •TruView PCD offers better pediatric intubation conditions than the Macintosh laryngoscope.

Project description:BACKGROUND:Maintaining cervical immobilization is essential during tracheal intubation in patients with unstable cervical spines. When using the Macintosh laryngoscope for intubation in patients with cervical immobilization, substantial neck extension is required for visualization of the glottis. However, the C-MAC D-Blade videolaryngoscope may require less neck extension due to its acute angulation. We hypothesized that C-MAC D-Blade videolaryngoscopic intubation would result in less cervical spine movement than Macintosh laryngoscopic intubation. We compared the effects of C-MAC D-Blade videolaryngoscopic intubation and Macintosh laryngoscopic intubation in terms of cervical spine motion during intubation in patients with simulated cervical immobilization. METHODS:In this randomized crossover study, the cervical spine angle was measured at the occiput-C1, C1-C2, and C2-C5 segments before and during tracheal intubation with either a C-MAC D-Blade videolaryngoscope or Macintosh laryngoscope in 20 patients, with application of a neck collar for simulated cervical immobilization. Cervical spine motion was defined as the change in angle measured before and during tracheal intubation. RESULTS:The cervical spine motion at the occiput-C1 segment was measured at 12.1?±?4.2° and 6.8?±?5.0° during Macintosh laryngoscopic and C-MAC D-blade videolaryngoscopic intubation, respectively, corresponding to a 44% reduction in cervical spine motion when using the latter device (mean difference, -?5.3; 98.33% CI: -?8.8 to -?1.8; p?=?0.001). However, there was no significant difference between the two intubation devices at the C1-C2 segment (-?0.6; 98.33% CI: -?3.4 to 2.2; p?=?0.639) or C2-C5 segment (0.2; 98.33% CI: -?6.0 to 6.4; p?=?0.929). CONCLUSIONS:The C-MAC D-Blade videolaryngoscope causes less upper cervical spine motion than the Macintosh laryngoscope during tracheal intubation of patients with simulated cervical immobilization. TRIAL REGISTRATION:This study was registered at ClinicalTrials.gov on June 26, 2018 ( NCT03567902 ).

Dataset Information

Using King Vision video laryngoscope with a channeled blade prolongs time for tracheal intubation in different training levels, compared to non-channeled blade.

Publications

Using King Vision video laryngoscope with a channeled blade prolongs time for tracheal intubation in different training levels, compared to non-channeled blade.

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