In reply: Comparing devices for managing the difficult airway

Petzoldt, Martin; Grün, Catharina; Wünsch, Viktor A.; Bauer, Marcus; Hardel, Tim T.; Grensemann, Jörn

doi:10.1007/s12630-023-02627-8

Cited by 1 publication

(1 citation statement)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A current metanalysis did not reveal significant differences between hyperangulated and Macintosh videolaryngoscopes with regard to POGO ( 13 , 25 ) and currently data underscoring a beneficial effect of direct epiglottis lifting with Macintosh videolaryngoscopes are very limited ( 17 , 19 ). Epiglottis lifting techniques have been identified as the missing piece of the puzzle in assessing difficult airway management ( 11 , 26 ). Although important for decision-making in time-critical situations, it is unknown if direct epiglottis lifting or conversion to hyperangulated videolaryngoscopy improves glottis visualization equally well.…”

Section: Introductionmentioning

confidence: 99%

Hyperangulated blades or direct epiglottis lifting to optimize glottis visualization in difficult Macintosh videolaryngoscopy: a non-inferiority analysis of a prospective observational study

Wünsch,

Köhl,

Breitfeld

et al. 2023

Front. Med.

Self Cite

View full text Add to dashboard Cite

PurposeIt is unknown if direct epiglottis lifting or conversion to hyperangulated videolaryngoscopes, or even direct epiglottis lifting with hyperangulated videolaryngoscopes, may optimize glottis visualization in situations where Macintosh videolaryngoscopy turns out to be more difficult than expected. This study aims to determine if the percentage of glottic opening (POGO) improvement achieved by direct epiglottis lifting is non-inferior to the one accomplished by a conversion to hyperangulated videolaryngoscopy in these situations.MethodsOne or more optimization techniques were applied in 129 difficult Macintosh videolaryngoscopy cases in this secondary analysis of a prospective observational study. Stored videos were reviewed by at least three independent observers who assessed the POGO and six glottis view grades. A linear mixed regression and a linear regression model were fitted. Estimated marginal means were used to analyze differences between optimization maneuvers.ResultsIn this study, 163 optimization maneuvers (77 direct epiglottis lifting, 57 hyperangulated videolaryngoscopy and 29 direct epiglottis lifting with a hyperangulated videolaryngoscope) were applied exclusively or sequentially. Vocal cords were not visible in 91.5% of the cases with Macintosh videolaryngoscopy, 24.7% with direct epiglottis lifting, 36.8% with hyperangulated videolaryngoscopy and 0% with direct lifting with a hyperangulated videolaryngoscope. Conversion to direct epiglottis lifting improved POGO (mean + 49.7%; 95% confidence interval [CI] 41.4 to 58.0; p < 0.001) and glottis view (mean + 2.2 grades; 95% CI 1.9 to 2.5; p < 0.001). Conversion to hyperangulated videolaryngoscopy improved POGO (mean + 43.7%; 95% CI 34.1 to 53.3; p < 0.001) and glottis view (mean + 1.9 grades; 95% CI 1.6 to 2.2; p < 0.001). The difference in POGO improvement between conversion to direct epiglottis lifting and conversion to hyperangulated videolaryngoscopy is: mean 6.0%; 95% CI −6.5–18.5%; hence non-inferiority was confirmed.ConclusionWhen Macintosh videolaryngoscopy turned out to be difficult, glottis exposure with direct epiglottis lifting was non-inferior to the one gathered by conversion to hyperangulated videolaryngoscopy. A combination of both maneuvers yields the best result.Clinical trial registrationClinicalTrials.gov, NCT03950934.

show abstract