Pre-formed endotracheal tube and stepwise insertion for more successful intubation with video laryngoscopy

ARTICLE HIGHLIGHTS

Research background

Despite the wide use of video laryngoscopy (VL) for intubation, conflicting results have been reported regarding its usefulness. A new technique was introduced with the aim of improving the success rate of VL intubation. This technique includes pre-forming the tracheal tube, followed by a stepwise insertion process during VL intubation.

Research motivation

The “can see but can’t intubate” scenario is frequently reported during intubation with VL. We believe that the new technique will provide room for better manipulation of the tracheal tube, providing higher first pass rate and allowing for use of less force. In the future, a pre-formed tube with memory to negotiate for intubation could be introduced for more convenient and successful practice.

Research objectives

The objective of the study was to increase the success of intubation during VL.

Research methods

First, a mannequin trial was conducted with operators having different experience levels and backgrounds. Then, a retrospective analysis was performed for an > 1-year period with patients who underwent general anesthesia with orotracheal intubation. The endotracheal tube used had been pre-formed with two curves, which was then applied in a stepwise intubation process with direct eye vision, followed by screen assistance to direct it toward the glottis. In the mannequin trial, the outcome measures were quantification of torque (force with angular acceleration during levering), need for external maneuvers, and time to intubate. In the clinical experience, orotracheal intubation used VL (pre-formed tube) or direct laryngoscopy (DL) at the anesthetist’s discretion, and throat discomfort was reported by the patient.

Research results

In the mannequin trials using VL, there was less torque required and a higher first pass rate achieved with the pre-formed tube than with a regular tube. In clinical practice, second attempts by readjustment of the curve of the tube were significantly fewer with VL than with DL, and throat discomfort was reported by fewer patients who underwent VL.

Research conclusions

The use of a pre-formed endotracheal tube and a combination of direct vision and video monitoring screen guidance, with careful rotation of the tracheal tube, is associated with less torque and fewer external maneuvers. The technique carries potential for a higher first-pass success rate and less postoperative throat discomfort. Nonetheless, VL requires special tactics and may warrant training and orientation.