Elective Tracheal Intubation With the VieScope—A Prospective Randomized Non-inferiority Pilot Study (VieScOP-Trial)

Abstract

BackgroundTracheal intubation is commonly performed after direct laryngoscopy using Macintosh laryngoscopes (MacL), but visualization of the larynx may be inadequate. The VieScope (VSC) as a new type of laryngoscope consisting of a straight, shielded, illuminated tube used to perform intubation via a bougie was investigated in this prospective randomized trial in patients without expected difficult airways.MethodsWith ethics approval, 2 × 29 patients for elective surgery were randomized 1:1 to intubation with VSC or MacL. Endpoints were first attempt success rates (FAS), Percentage of Glottis Opening Scale (POGO), time to intubation (TTI), and difficulty ratings on visual analog scales (0–100, lower values better). Data are given as mean ± standard deviation.ResultsThe FAS was 83 ± 38% for VSC and 86 ± 34% for MacL (P = 0.723). For VSC, POGO was 86 ± 17% and for MacL 68 ± 30% (P = 0.007). TTI for VSC was 93 ± 67s vs. 38 ± 17 for MacL (P < 0.001). Difficulty of intubation was rated 23 ± 22 for VSC vs. 18 ± 22 for MacL (P = 0.422), viewing conditions 12 ± 15 vs. 24 ± 25 (P = 0.031), and difficulty of tube placement was rated 27 ± 30 vs. 7 ± 8 (P = 0.001).ConclusionNo difference in FAS was detected between VSC and MacL. Visualization of the larynx was superior using the VSC, while TTI was prolonged and tube placement via bougie was more challenging. The VSC could be an alternative to MacL in patients with difficult laryngoscopy, but this should be investigated further in patients with expected difficult airways.

In reply: Parallel intubation technique with the Vie Scope® laryngoscope

“…We thank Dr. Henlin et al . 1 for their interest in our work 2 and for sharing their interesting insights into the “parallel intubation technique.” We are pleased that the authors’ experience is consistent with our previously published study results 2 , 3 suggesting that glottis visualization with the Vie Scope ® (Adroit Surgical LLC, Oklahoma City, OK, USA) is superior to direct laryngoscopy and noninferior to Macintosh videolaryngoscopy, despite increased time-to-intubation. 2 , 3 In our opinion, the good visualization achieved with the Vie Scope is primarily due to direct epiglottis lifting, being a key element of straight-blade techniques and also significantly improving the glottis exposure in difficult Macintosh videolaryngoscopy.…”

“…Nevertheless, some potential disadvantages of the Vie Scope must be considered: The Vie Scope is designed to be used in a two-step bougie-assisted approach that prolongs time-to-intubation compared with a direct approach. 2 , 3 The tracheal tube is railroaded over the bougie without visualization of the laryngeal inlet; therefore, tube advancement cannot be visualized and tube impingement on the anterior commissure or arytenoids cannot be visually confirmed. 3 Correct bougie placement may not be verified through the Vie Scope in situations with significantly restricted glottis view through the channel (i.e., grade 2C or worse); 4 , 5 in our previous study, we observed four unintended esophageal intubations in patients with expected difficult airways 2 probably due to bougie misplacement.…”

“…The Vie Scope is designed to be used in a two-step bougie-assisted approach that prolongs time-to-intubation compared with a direct approach. 2 , 3 …”

“…The tracheal tube is railroaded over the bougie without visualization of the laryngeal inlet; therefore, tube advancement cannot be visualized and tube impingement on the anterior commissure or arytenoids cannot be visually confirmed. 3 …”

A Comparison of the bébé VieScope™ and Direct Laryngoscope for Use While Wearing PPE-AGP: A Randomized Crossover Simulation Trial

“…Petzoldt et al published a study on elective endotracheal intubation using VieScope and Macintosh laryngoscope in adult patients [ 17 ]. They measured first-attempt success rates, percentage of glottis opening scale, time to intubation, and difficulty ratings on visual analogue scales.…”