UCONN Emergency Medicine Interest Group

Posts Tagged ‘airway’

Journal Article Synopsis: Glidescope vs. Direct Laryngoscopy

In JOURNAL CLUB on July 31, 2011 at 2:57 PM

Summary for “Tracheal Intubation in the Emergency Department: A Comparison of GlideScope® Video Laryngoscopy to Direct Laryngoscopy in 822 Intubations” by John C. Sakles et al. in The Journal of Emergency Medicine.

What is already known on this topic:
While video laryngoscopy has been available for ED physicians, there hasn’t been much done in terms of study in comparing the success rates of video versus conventional direct laryngoscopy, especially in the ED. Most studies have been conducted in the OR or simulation laboratory.

What question this study addressed:
This study addresses the question, “How successful are first attempt intubations of using video versus conventional direct laryngoscopy?” It also addresses the success rate of second attempts, the key features and reasons for failure between the two devices.

What was the study design:
This study is a 24 month retrospective observation study on data collected concurrently between July 1, 2007 to June 30, 2009 on all ED patients intubated in a single academic ED with a Level I trauma center, belonging to a tertiary urban university. A one-page data collection sheet was completed by the operator upon completion of each intubation. The data forms were cross-referenced with the billing form to make sure missing forms were filled out. Video laryngoscopy (GVL) was done using GlideScope® standard, Colbat or Ranger. Conventional direct larygoscopy  (DL) was done using a traditional Miller/Macintosh laryngoscope.

What this study adds to our knowledge:
Prior studies in the OR and/or simulation laboratory have shown GVL to have faster and greater first time success rates compared to DL, especially in cases of cervical immobilization. However, most studies showed minimal to no difference in the use of either of these devices.

From this study, it showed that GVL indeed had a higher first time success rate in comparison to DL, especially in instances where there were two or more predicators for a difficult airway. However, in instances where more than one attempt was required, DL had better success rate than GVL. This is because the factors that cause GVL failure usually can’t be improved much, and physicians often abandon GVL for another device after failure of a first attempt, whereas with a DL, more attempts are usually tried before switching to another device, and failed attempts were usually improvable by adjusting the laryngoscope into a better position for a view of the glottic opening. Also, there were fewer esophageal intubations using GVL versus using DL.

How this is relevant to clinical practice:
This is relevant to clinical practice because intubation is a life-saving procedure that is performed in the ED on a daily basis. For patients with difficult airways, GVL is a viable solution to assist the physician in being able to acquire a view of the glottic opening for the intubation. GVL has been used by anesthesia in OR patients, and studies of its efficacy has been published. With these results of the use of GVL versus DL in the ED, this could possibly assist ED physicians in their choice of laryngoscopic device for patients.

Other considerations:
Future studies should be conducted regarding the comparison of each device in difficult airway situations.

EM Images #2

In IMAGES on May 12, 2011 at 7:54 PM

Syndicated from the UCONN EM Residency website; credit to Dr. Ratzan for images and text.

The following patient presented with swelling of the tongue for several hours duration without any dyspnea. She had never had this before. She had a past medical history of hypertension, CHF, hypothyroidism, rheumatoid arthritis, diabetes mellitus, dementia and was on synthroid, lisinopril and glucophage. Physical examination was negative except for the massively edematous tongue. No stridor and normal breath sounds. EKG and O2 sats were normal.

What does this patient have? What would you do and why? (click below to see the answer below the fold)

Read the rest of this entry »

%d bloggers like this: