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Improved glottic exposure with the Video Macintosh Laryngoscope in adult emergency department tracheal intubations.

Abstract：

STUDY OBJECTIVE:Glottic visualization with video is superior to direct laryngoscopy in controlled operating room studies. However, glottic exposure with video laryngoscopy has not been evaluated in the emergency department (ED) setting, where blood, secretions, poor patient positioning, and physiologic derangement can complicate laryngoscopy. We measure the difference in glottic visualization with video versus direct laryngoscopy. METHODS:We prospectively studied a convenience sample of tracheal intubations at 2 academic EDs. We performed laryngoscopy with the Karl Storz Video Macintosh Laryngoscope, which can be used for conventional direct laryngoscopy, as well as video laryngoscopy. We rated glottic visualization with the Cormack-Lehane (C-L) Scale, defining "good" visualization as C-L I or II and "poor" visualization as C-L III or IV. We compared glottic exposure between direct and video laryngoscopy, determining the proportion of poor direct visualizations improved to good visualization with video laryngoscopy. We also determined the proportion of good direct visualizations worsened to poor visualization by video laryngoscopy. RESULTS:We report data on 198 patients, including 146 (74%) medical, 51 (26%) trauma, and 1 (0.51%) unknown indications. All were tracheally intubated by emergency physicians. Postgraduate year 3 or 4 residents performed 102 (52.3%) of the laryngoscopies, postgraduate year 2 residents performed 60 (30.8%), interns performed 20 (10.3%), attending physicians performed 9 (4.6%), and operator experience and specialty were not reported in 4. Overall, good visualization (C-L grade I or II) was attained in 158 direct (80%) versus 185 video laryngoscopies (93%; McNemar's P<.0001). Of the 40 patients with poor glottic exposure on direct laryngoscopy, video laryngoscopy improved the view in 31 (78%; 95% confidence interval 62% to 89%). Of the 158 patients with good glottic view on direct laryngoscopy, video laryngoscopy worsened the view in 4 (3%; 95% confidence interval 0.7% to 6%). CONCLUSION:Video laryngoscopy affords more grade I and II views than direct laryngoscopy and improves glottic exposure in most patients with poor direct glottic visualization. In a small proportion of cases, glottic exposure is worse with video than direct laryngoscopy.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Brown CA 3rd,Bair AE,Pallin DJ,Laurin EG,Walls RM,National Emergency Airway Registry (NEAR) Investigators.

doi

10.1016/j.annemergmed.2010.01.033

subject

Has Abstract

pub_date

2010-08-01 00:00:00

pages

83-8

issue

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(10)00108-3

journal_volume

pub_type

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Improved glottic exposure with the Video Macintosh Laryngoscope in adult emergency department tracheal intubations.