Videolaryngoscopy in critically ill patients.

Intubation is frequently required for patients in the intensive care unit (ICU) but is associated with high morbidity and mortality mainly in emergency procedures and in the presence of severe organ failures. Improving the intubation procedure is a major goal for all ICU physicians worldwide, and videolaryngoscopy may play a relevant role.Videolaryngoscopes are a heterogeneous entity, including Macintosh blade-shaped optical laryngoscopes, anatomically shaped blade without a tube guide and anatomically shaped blade with a tube guide, which might have theoretical benefits and pitfalls. Videolaryngoscope/videolaryngoscopy improves glottis view and allows supervision by an expert during the intubation process; however, randomized controlled trials in the ICU suggest that the systematic use of videolaryngoscopes for every intubation cannot yet be recommended, especially in non-expert hands. Nevertheless, a videolaryngoscope should be available in all ICUs as a powerful tool to rescue difficult intubation or unsuccessful first-pass laryngoscopy, especially in expert hands.The use of associated devices such as bougie or stylet, glottis view needed (full vs incomplete) and patient position during intubation (ramped, sniffed position) should be further evaluated. Future trials will better define the role of videolaryngoscopy in ICU.

Outcomes in video laryngoscopy studies from 2007 to 2017: systematic review and analysis of primary and secondary endpoints for a core set of outcomes in video laryngoscopy research.

BACKGROUND: Airway management is crucial and, probably, even the most important key competence in anaesthesiology, which directly influences patient safety and outcome. However, high-quality research is rarely published and studies usually have different primary or secondary endpoints which impedes clear unbiased comparisons between studies. The aim of the present study was to gather and analyse primary and secondary endpoints in video laryngoscopy studies being published over the last ten years and to create a core set of uniform or homogeneous outcomes (COS). METHODS: Retrospective analysis. Data were identified by using MEDLINE® database and the terms "video laryngoscopy" and "video laryngoscope" limited to the years 2007 to 2017. A total of 3351 studies were identified by the applied search strategy in PubMed. Papers were screened by two anaesthesiologists independently to identify study endpoints. The DELPHI method was used for consensus finding. RESULTS: In the 372 studies analysed and included, 49 different outcome categories/columns were reported. The items "time to intubation" (65.86%), "laryngeal view grade" (44.89%), "successful intubation rate" (36.56%), "number of intubation attempts" (23.39%), "complications" (21.24%), and "successful first-pass intubation rate" (19.09%) were reported most frequently. A total of 19 specific parameters is recommended. CONCLUSIONS: In recent video laryngoscopy studies, many different and inhomogeneous parameters were used as outcome descriptors/endpoints. Based on these findings, we recommend that 19 specific parameters (e.g., "time to intubation" (inserting the laryngoscope to first ventilation), "laryngeal view grade" (C&L and POGO), "successful intubation rate", etc.) should be used in coming research to facilitate future comparisons of video laryngoscopy studies.

¿Ha muerto la laringoscopia directa? Larga vida a la videolaringoscopia / Is direct laryngoscopy dead? Long live the video laryngoscopy

No disponible

Supraglottic airway device versus a channeled or non-channeled blade-type videolaryngoscope for accidental extubation in the prone position: A randomized crossover manikin study.

BACKGROUND: It is very rare but challenging to perform emergency airway management for accidental extubation in a patient whose head and neck are fixed in the prone position when urgently turning the patient to the supine position would be unsafe. The authors hypothesized that tracheal intubation with a videolaryngoscope would allow effective airway rescue in this situation compared with a supraglottic airway device and designed a randomized crossover manikin study to test this hypothesis. METHODS: The authors compared airway rescue performances of the 3 devices-the ProSeal laryngeal mask airway (PLMA; Teleflex Medical, Westmeath, Ireland) as a reference; the Pentax AWS (AWS; Nihon Kohden, Tokyo, Japan) as a channeled blade-type videolaryngoscope; and the McGRATH videolaryngoscope (McGRATH; Medtronic, Minneapolis, MN) as a nonchanneled blade type in a manikin fixed to the operating table in the prone position. Twenty-one anesthesiologists performed airway management on the prone manikin with the 3 devices, and the time required for intubation/ventilation and the success rates were recorded. RESULTS: The median (range) intubation/ventilation times with the PLMA, AWS, and McGRATH were 24.5 (13.5-89.5) s, 29.9 (17.1-79.8) s, and 46.7 (21.9-211.7) s, respectively. There was no significant difference in intubation/ventilation times between the PLMA and AWS. The AWS permitted significantly faster tracheal intubation than did the McGRATH (P = 0.006). The success rates with the PLMA (100%) and AWS (100%) were significantly greater than that with the McGRATH (71.4%). Airway management performance of the PLMA and AWS was comparable between devices and better than that of the McGRATH in the prone position. CONCLUSIONS: Considering that tracheal intubation can provide a more secure airway and more stable ventilation than the PLMA, re-intubation with a channeled blade-type videolaryngoscope such as the AWS may be a useful method of airway rescue for accidental extubation in patients in the prone position.

A Study on the Tactical Safety of Endotracheal Intubation Under Darkness.

OBJECTIVE: Strict blackout discipline is extremely important for all military units. To be able to effectively determine wound characteristics and perform the necessary interventions at nighttime, vision and light restrictions can be mitigated through the use of tactical night vision goggles (NVGs). The lamp of the classical laryngoscope (CL) can be seen with the naked eye; infrared light, on the other hand, cannot be perceived without the use of NVGs. The aim of the study is to evaluate the safety of endotracheal intubation (ETI) procedures in the dark under tactically safe conditions with modified laryngoscope (ML) model. METHODS: We developed an ML model by changing the standard lamp on a CL with an infrared light-emitting diode lamp to obtain a tool which can be used to perform ETI under night conditions in combination with NVGs. We first evaluated the safety of ETI procedures in prehospital conditions under darkness by using both the CL and the ML for the study, and then researched the procedures and methods by which ETI procedure could be performed in the dark under tactically safe conditions. In addition, to better ensure light discipline in the field of combat, we also researched the benefits, from a light discipline standpoint, of using the poncho liner (PL) and of taking advantage of the oropharyngeal region during ETIs performed by opening the laryngoscope blades directly in the mouth and using a cover. During the ETI procedures performed on the field, two experienced combatant staff simulated the enemy by determining whether the light from the two different types of laryngoscope could be seen at 100-m intervals up to 1,500 m. RESULTS: In all scenarios, performing observations with an NVG was more advantageous for the enemy than with the naked eye. The best measure that can be taken against this threat by the paramedic is to ensure tactical safety by having an ML and by opening the ML inside the mouth with the aid of a PL. The findings of the study are likely to shed light on the tactical safety of ETI performed with NVGs under darkness. CONCLUSION: Considering this finding, we still strongly recommend that it would be relatively safer to open the ML blade inside the mouth and to perform the procedures under a PL. In chaotic environments where it might become necessary to provide civilian health services for humanitarian aid purposes (Red Crescent, Red Cross, etc.) without NVGs, we believe that it would be relatively safer to open the CL blade inside the mouth and to perform the procedures under a PL.

[Video laryngoscopy olé! Time to say good bye to direct and flexible intubation?]. / Videolaryngoskopie olé! Direkte und flexible Intubationsverfahren ade?

A number of video laryngoscopy systems have been introduced into anesthetic practice in recent years. Due to the technical concepts of these systems exposure of the laryngeal structures is usually better than with direct laryngoscopy, both in normal airways as well as in those that are difficult to manage. With the increasing use of video laryngoscopy it seems as if direct laryngoscopy and flexible fibrescopic intubation are at risk of becoming redundant. This article describes current developments and discusses why expertise in direct laryngoscopy and flexible fibrescopic intubation should be maintained, particularly by experts in airway management.

Utilidad del laringoscopio de suspensión de Kleinsasser para facilitar la intubación orotraqueal en tumores supraglóticos de laringe / No disponible

No disponible

Intubación con tubo de doble luz mediante laringoscopio Airtraq® en dos pacientes despiertos con vía aérea díficil prevista / Double lumen tube insertion in awake patients through the AirTraq laryngoscope in 2 cases of expected difficult airway

La posibilidad de hallar un paciente con vía aérea difícil (VAD) en cirugía torácica aumenta por la coexistencia de patología oncológica faringo-laríngea asociada. El uso de tubos de doble luz para el aislamiento pulmonar supone una dificultad añadida en estas situaciones. Diversos dispositivos ópticos diseñados en los últimos años, aportan nuevas soluciones disponibles para el manejo de estos casos. Presentamos dos pacientes con VAD conocida, programados para resección pulmonar, en los que se utilizó con éxito el laringoscopio Airtraq® para la inserción de tubo de doble luz con el paciente despierto. Este laringoscopio no requiere desplazamiento de la lengua, ni tracción de la vallécula, lo que facilita su tolerancia en pacientes despiertos(AU)

The likelihood of difficult airway in thoracic surgery increases in the presence of associated cancer of the pharynx or larynx. The difficulty is greater when a double lumen tube must be inserted in these conditions, and various newly developed optical devices offer solutions for managing such cases. We report on 2 patients with expected difficult airway who were scheduled for lung resection. In both cases, intubation was accomplished through the AirTraq laryngoscope while the patient remained awake. Awake patient tolerance is facilitated by this laryngoscope, because the tube can be inserted without changing the position of the tongue or placing pressure on the vallecula(AU)

Intubación de un paciente despierto con vía aérea difícil conocida utilizando el laringoscopio Airtraq(R) / No disponible

No disponible

Comentarios al artículo "Uso del videolaringoscopio de McGrath junto con la gúía frova en el manejo de la vía aérea difícil" / No disponible

No disponible

Réplica a los comentarios al artículo "Uso del videolaringoscopio de Mcgraft junto con la guía frova en el manejo de la vía aérea difícil" / No disponible

No disponible

Utilización del laringoscopio rígido y el nasofibroscopio flexible en la valoración de la vía aérea difícil: descripción de 3 casos / Use of a rigid laryngoscope and a flexible nasal fiberoptic scope to assess the difficult airway: description of 3 cases

La exploración de los pacientes con criterios de dificultaden el manejo de la vía aérea puede ser ampliadacon la realización de una laringoscopia indirecta utilizandoel laringoscopio rígido de 70º y el nasofibroscopioflexible. Son útiles para detectar anomalías estructurales,se acoplan al mismo sistema de visualización y noprecisan anestesia tópica ni sedación de los pacientes.Presentamos 3 pacientes diagnosticados de vía aéreadifícil, a los que se les realizó en la consulta de valoraciónpreanestésica una laringoscopia con el laringoscopiorígido. Se observó en el primero la falta de epiglotis,en el segundo una deformidad epiglótica y en el tercerouna hipertrofia de la base de la lengua, anormalidadesque impedían la visión de la glotis. Se les practicó unalaringoscopia con el nasofibroscopio flexible que permitióobservar la glotis sin obstáculos. La visión completade la vía aérea facilitó la elección del método de intubación(AU)

Indirect inspection of the airway using a 70° rigidlaryngoscope plus a flexible nasal fiberoptic scope canprovide additional information when the anesthesiologistforesees that airway management will be difficult. Thesedevices are useful for detecting structural abnormalities,they can be attached to the same visualization system, andthey do not require topical anesthesia or sedation of thepatient. We report on 3 patients diagnosed with difficultairway. Inspection with a rigid laryngoscope during thepreanesthetic assessment visit revealed abnormalities thatprevented visualization of the glottis. In the first case, theepiglottis was absent, as it had been removed with asurrounding tumor; in the second and third cases, anepiglottic deformity and hypertrophy of the base of thetongue were found. A flexible nasal fiberoptic scope gavean unobstructed view of the glottis in these cases, makingit easier to choose an intubation method(AU)

Usos clínicos del videolaringoscopio McGrath® / No disponible

Dos de los principales objetivos de todo anestesiólogo es el manejo de la vía aérea y el mantenimiento de la oxigenación del paciente. Las complicaciones derivadas del inadecuado logro de estos objetivos constituyen la primera causa de accidentes y la primera causa de demandas legales. Desde su invención, el laringoscopio de Macintosh ha sido el más usado en la práctica clínica diaria. Un gran adelanto tecnológico ha sido la aparición en el mercado de los videolaringoscopios, entre los que destaca el McGrath®, dispositivo totalmente portátil y de fácil empleo, que nos permite mejorar el grado de visión de la laringe durante la maniobra de intubación traqueal, con respecto a la laringoscopia directa, en diversas situaciones. Entre las ventajas de su uso destacan la completa portabilidad, la ausencia de necesidad de esterilización entre pacientes y la fácil desarticulación de la pala y el mango (AU)

Two of the main objectives of any anesthesiologist are airway management and maintenance of the oxygenation of the patient. Complications arising from inadequate achievement of these goals are the primary cause of accidents and the leading cause of lawsuits. Since its invention, the Macintosh laryngoscope has been the most used in daily clinical practice. A technological breakthrough has been the emergence in the market for videolaryngoscopes, most notably the McGrath®, completely portable device and easy to use, allowing us to improve the degree of vision of the larynx during tracheal intubation maneuver with respect to direct laryngoscopy, in various situations. Among the advantages of its use include the complete portability, no need for sterilization between patients and the easy disarticulation of the blade and the handle (AU)

La nueva era de los laringoscopios ópticos / No disponible

No disponible

Manejo de la vía aérea fácil y complicada con el laringoscopio óptico Airtraq® en manos inexpertas / Management of the easy or complicated airway by nonexperts using the AirTraq optical laryngoscope

OBJETIVO: Evaluar la utilidad del laringoscopio ópticoAirtraq®, evaluando sus indicaciones y beneficios, asícomo las posibles limitaciones de su empleo en una serieretrospectiva de pacientes.PACIENTES Y MÉTODOS: Revisión retrospectiva de losprimeros 124 pacientes de nuestro centro cuya intubaciónendotraqueal fue realizada con Airtraq®. Se tuvieronen cuenta variables anatómicas y demográficas delos pacientes, así como la exploración preoperatorio dela vía aérea. Tras la realización de la intubación con Airtraq® se recogieron datos en cuanto a su facilidad demanejo y calidad del procedimiento.RESULTADOS: En un 97,6% de los pacientes se consiguióuna intubación correcta y en sólo 3 (2,4%) pacientesfue imposible. La calidad de la laringoscopia fue óptimaen más del 95% de los casos. Las complicaciones eincidencias fueron mínimas.CONCLUSIÓN: El laringoscopio Airtraq® ha demostradoque facilita la intubación en aquellos casos en losque intentos previos de laringoscopia han sido infructuososy en pacientes con predictores evidentes de víaaérea difícil (VAD), incluso cuando fue empleado porpersonal no entrenado en su uso. La facilidad en suempleo y su relativa inocuidad, lo convierten en unpráctico dispositivo en distintos tipos de pacientes ysituaciones clínicas(AU)

OBJECTIVES: To evaluate the utility of the AirTraqoptical laryngoscope in a retrospective case series,assessing indications for use and benefits as well aspossible limitations.PATIENTS AND METHODS: Retrospective study of the first124 patients in whom we used the AirTraq for trachealintubation. Anatomical and demographic variables wererecorded in addition to preoperative findings onexamination of the airway. Ease in accomplishing themaneuver and quality of the procedure were assessedafter intubation with the AirTraq.RESULTS: The trachea was correctly intubated in97.6% of the patients. Intubation failed in only 3 (2.4%)patients. Laryngoscopic quality was optimal in over95% of the cases. There were few complications or otherevents.CONCLUSIONS: The AirTraq laryngoscope has beenshown to facilitate intubation even when nonexpert staffperform the maneuver in cases in which previousattempts at laryngoscopy have failed and in which adifficult airway is anticipated. Ease of use and relativesafety make the AirTraq a practical device for a varietyof patient types and clinical settings(AU)

Tratamiento de la vía aérea con airtaq® en un paciente con síndrome de Launois-Bensaude / No disponible

No disponible

Pediatric laryngoscopes and intubation aids old and new.

This review summarizes the evolution of the pediatric laryngoscope using some of the established landmarks in the history of anesthesia. Children were rarely intubated before 1940 though the subsequent 30 years saw a proliferation of pediatric laryngoscopes in part driven by the developments in pediatric anesthesia and surgery, manufacturing techniques and materials and a change in airway management philosophy exemplified by Jackson Rees's argument against the notion that intubation was to be avoided in children. A perspective on the present day describes the modifications to popular straight and curved blade laryngoscopes and the development of new devices that enhance direct visualization of the larynx. There are an ever-increasing number of laryngoscope devices that assist in indirect visualization of the larynx such as rigid optical stylets and flexible fiber-optic scopes. Images from many of these devices may be enhanced by digital camera or real-time video technology. The prospect of future laryngoscope development is glimpsed in the arrival of light emitting diode light source technology and questions remain regarding the consequences of equipment disposability and at the fidelity of disposable equipment manufacture.

Un nuevo dispositivo para el abordaje de la vía respiratoria anatómicamente difícil: el Airtraq ® / _A new device for a respiratory airway of difficult anatomically access: The Airtrak®

La vía respiratoria anatómicamente difícil, resulta un reto al anestesiólogo. Múltiples son las opciones que existen para resolverlas. Recientemente, el laringoscopio óptico Airtraq ®, constituye una opción válida para abordar la tráquea en estas condiciones. Proporcionar la enseñanza de un nuevo dispositivo para el abordaje de la vía respiratoria anatómicamente difícil. Se propuso realizar el proceso de enseñanza aprendizaje con el laringoscopio óptico Airtraq ® para adquirir las habilidades suficientes y necesarias para poder realizar el abordaje de la vía respiratoria en general y de la vía respiratoria anatómicamente difícil en particular. Se describió la forma de colocar el dispositivo y las ventajas de su uso. CEl Airtraq ®, es un dispositivos para el abordaje de la vía respiratoria anatómicamente difícil que puede ser utilizado de forma rápida y fácil(AU)

The airway anatomically difficult is a challenge for anesthesiologist.There many options for its solution. Recently, the optical laryngoscope Airtraq®, is a valid option to approach the trachea in these conditions.To teach on a new device to approach the airway anatomically difficult.We propose to carry out the teaching process with optical laryngoscope Airtraq® to acquire abilities sufficient and necessary to carry out the approach of the airway in general and of the airway anatomically difficult in particular. We described the way to insert the device and the advantages of its use.Airtraq® is a device to approach this type of airway that may to be used in a fast and easy way(AU)