Use of a Combined Laryngo-Bronchoscopy Approach in Difficult Airways Management: A Pilot Simulation Study

Abstract

Objective: There are several airway devices available for difficult tracheal intubation (DTI) management, but the failure rate remains high. The use of laryngoscopy to facilitate the fibreoptic-bronchoscope intubation (CLBI) has been increasingly reported in DTI situations, but it has not been formally studied yet. Methods:We designed a single-centre simulation study on DTI (neck rigidity and tongue oedema) comparing three techniques: direct laryngoscopy (DL), video-laryngoscopy (VLS) and CLBI. Eighteen anaesthesiologists naïve to VLS/CLBI approaches, participated in the study. The primary outcome was the intubation rate at the first attempt. Secondary outcomes were an overall time-to-intubate (TTI) and time-to-ventilate (TTV), success at the second and third attempt and ease of intubation as evaluated by a subjective 5-point Likert scale. Results:The CLBI technique had a higher success rate at the first attempt than DL (66% vs 22%, p=0.007), while VLS did not (44%, p=0.16). A trend towards higher success at the third attempt was found for both VLS and CLBI vs DL (p=0.07 and p=0.06, respectively). The VLS had a shorter overall TTV than DL (88±60 vs 121±59 sec, respectively, p=0.04) and a trend towards a shorter TTI (81±61 vs 116±64 sec, respectively, p=0.06). The CLBI approach showed a non-significantly lower TTI/TTV as compared to DL (p=0.10 and p=0.16, respectively). Anaesthesiologists judged that the intubation with VLS (3.7±1.0) and CLBI (3.8±1.0) was easier than with DL (1.7±0.8, both p<0.001). Conclusion:In a simulated DTI scenario, CLBI had a higher success rate at the first attempt than DL, while VLS did not. By the third attempt, both rescue techniques had a trend towards a higher success rate than DL. The CLBI technique seems a promising alternative for the management of DTI.

A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

“…Combined use of DL/VL with FOB has been a common alternative in certain anticipated difficult airways [223][224][225][226][227][228][229][230][231]. Similarly, it has also been thought to combine VL and a particular shaped stylet (or bougie-kind of introducer).…”

Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing considerations for complications

“…Previous research indicated that endotracheal intubation was achieved in only 13 of 35 (37%) children with PRS under direct laryngoscopy, and intubation using FB was applied to the remaining 22 of 35 (63%) who failed[ 11 ]. Sanfilippo et al [ 13 ] reported that the success rates of video-laryngoscopy and direct laryngoscopy in difficult tracheal intubation were 83% and 55%, respectively, while the rate was equal to 100% in the current research. However, in terms of complications, direct laryngoscopy is prone to endanger children’s lives due to a high failure rate of intubation[ 13 ].…”

“…Sanfilippo et al [ 13 ] reported that the success rates of video-laryngoscopy and direct laryngoscopy in difficult tracheal intubation were 83% and 55%, respectively, while the rate was equal to 100% in the current research. However, in terms of complications, direct laryngoscopy is prone to endanger children’s lives due to a high failure rate of intubation[ 13 ]. Although video-laryngoscopy also has high success rates in difficult tracheal intubation[ 9 ], the reported failure rates and severe complications must be taken into account[ 14 ].…”

To Compare Mean Time Taken for Tracheal Intubation with Airtraq Versus Macintosh Laryngoscope in Elective Surgeries: A Randomised Clinical Trial

“…Various studies have shown that Airtraq reduces intubation time for experienced as well as novice intubators [6][7]. Another study showed that the Airtraq significantly improved intubation time in difficult airways [8]. In one comparative study duration of tracheal intubation was 18±2.6 with airtraq laryngoscope versus 29±5.04 with macintosh laryngoscope with p value of 0.001 [9].…”