The usefulness of endotracheal tube twisting in facilitating tube delivery to glottis opening during GlideScope intubation in infants: randomized trial

Abstract

Despite an excellent view of the glottis, technical difficulties with endotracheal tube delivery remains in GlideScope intubation. We evaluated whether a spiral-shape twisted tube can facilitate placement of the tracheal tube tip at the center of glottis opening compared to conventional tube for GlideScope intubation in infants. eighty-six infants were randomly placed in either the conventional tube group (group C) or the twist tube group (group T). In group T, the shaft of the tube was manually twisted into a loose spiral shape. the primary outcome was the initial center location of the tube tip at the glottis opening, and the secondary outcome was total tube handling time. The initial center location rate of the tube tip at the glottis opening was significantly higher in group T than in group C (88% [38/43] vs. 47% [20/43], P < 0.001). In addition, total tube handling time (sec) was significantly shorter in group T than in group C (15.4 ± 4.7 vs. 18.2 ± 5.3, P = 0.012). In this study, the spiral shape twist tube successfully improved the rate of initial center location of the tube tip at glottis opening and facilitated tube delivery in GlideScope intubation in infants.

Effects of tip‐manipulated stylet angle on intubation using the GlideScope® videolaryngoscope in children: A prospective randomized controlled trial

“…Therefore, we hypothesized that additional curvature of ETT tip to the left could ease the targeting of ETT into the glottis and result in faster intubation compared with the standard curve. Our hypothesis was proven right as the time required to approach the glottis could be significantly reduced by approximately 2.4 s. Additionally, we could reduce the total intubation time by approximately 5 s. According to another pediatric study using the GlideScope, optimal angulation of the ETT curve could reduce the intubation time by approximately 3 s 10 . Although it might seem like a small difference, this finding is meaningful in pediatric patients with significant physiologic limits on the safe apnea time.…”

“…This might be due to a technical difficulty in ETT handling during intubation attempt 20 . This difficulty can be overcome using an optimal ETT curve 9,10,21 . An adult study using the GlideScope reported that optimal angulation of ETT could reduce the mean intubation time from 54.4 (28.2) sec to 47.1 (21.2) sec 9 …”

“…Manipulating the endotracheal tube (ETT) shape with the stylet can be a key factor in placing and advancing the ETT tip into the glottis 9,10 . ETT shape is usually formed similar to that of the GlideScope blade using a stylet 10 .…”

“…Manipulating the endotracheal tube (ETT) shape with the stylet can be a key factor in placing and advancing the ETT tip into the glottis 9,10 . ETT shape is usually formed similar to that of the GlideScope blade using a stylet 10 . However, additional handling is often required to place the tube tip into the glottis as it tends to be located on the right side of the laryngeal inlet during its insertion 10 .…”

“…ETT shape is usually formed similar to that of the GlideScope blade using a stylet 10 . However, additional handling is often required to place the tube tip into the glottis as it tends to be located on the right side of the laryngeal inlet during its insertion 10 . Additionally, the GlideScope blade may occupy a larger proportion of the oropharynx in pediatric patients, resulting in less space for manipulation of the ETT 11 .…”