Is Video Laryngoscope-Assisted Flexible Tracheoscope Intubation Feasible for Patients with Predicted Difficult Airway? A Prospective, Randomized Clinical Trial

Abstract

Flexible tracheoscope-assisted video laryngoscopic intubation is a feasible alternative to video laryngoscope only intubation in patients with predicted difficult airways. A flexible tracheoscope used in combination with video laryngoscope may also further increase the success rate of intubation in select patients with a proven difficult airway, particularly when in-line stabilization is required.

Unexpected Difficult Intubation. Is it a Solvable Problem? Reflections for a Safe Approach

“…A combined approach must be chosen . These combinations of McIntosch + Fob [15], VLS + FOB [13][14][15][16], AirTraq + FOB [17], VLS + Bonfils [14][15][16][17][18], McIntosch + Optical Stylet [19] have been reported to be successful under difficult conditions, which confirms that all stages of intubation should be performed under vision. The intervention must select one of the combined approaches that has the greatest likelihood of success, is the most secure, and is easy to perform, facilitating secure ventilation in the event of failure (face mask or extraglottic tools ) and allowing patient to awaken.…”

“…have success rates of 97-98% [10][11][12]. A combined approach using tools that display the glottic region and instruments that also display the trachea allows the tube to be introduced and placed under vision and resolves the majority of difficult cases [13][14][15][16].…”

Management and maintenance of the airway in cervical necrotising fasciitis: a retrospective analysis of 15 cases

“…[15][16][17] Some reports have suggested that tracheostomy is not routinely necessary and should not be used as the primary procedure for control of the airway in patients with Ludwig angina or infections of the deep spaces. 11,12 Video laryngoscopic intubation, being a relatively new technique, has been widely used in the management of difficult airways in recent years, 17,18 as it allows visualisation of the larynx without alignment of the oropharyngeal and laryngeal axis. It also provides excellent exposure and an improved laryngeal view with reduced intubation time, and has been used recently in the management of the airway in deep neck infections and Ludwig angina.…”

Strategies to improve first attempt success at intubation in critically ill patients

“…In operators with limited experience with flexible fiberoptic devices, a combined technique using a flexible fiberoptic device with a laryngoscope can be helpful. 103 Human factors: training, algorithms, and bundles…”