Utility of a Gum-Elastic Bougie for Difficult Airway Management in Infants: A Simulation-Based Crossover Analysis

Komasawa, Nobuyasu; Hyoda, Akira; Matsunami, Sayuri; Majima, Nozomi; Minami, Toshiaki

doi:10.1155/2015/617805

Cited by 12 publications

(3 citation statements)

References 23 publications

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“…An infant model was used in another model study by Komasawa et al [15]. In this study, no difference was found between ETI groups in normal (Cormack Lehane 1-2) and cervical stabilization (Cormack Lehane 3), using a Macintosh blade, with and without GEB.…”

Section: Discussionmentioning

confidence: 71%

Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

Birinci¹,

Özerol²,

Divriklioğlu³

et al. 2022

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Objective: Endotracheal intubation (ETI) in children requires good techniques and experience. Gum elastic bougie (GEB) is a practical, inexpensive, easy-to-use airway method in the adult airway. Through GEB, ETI is a method that can be learned after a short training. We evaluated the effectiveness of this method, which has not yet been validated in pediatric patients in prehospital pediatric airway applications. Materials and Methods:This study was designed as a study simulating the prehospital period with a mankin. Practitioners were asked to perform intubation by conventional intubation or GEB.Results: This study was conducted with 48 emergency medical technicians and paramedics. Four (8.3%) of the practitioners had experience using GEB. In terms of first-pass success, no difference was found between ETI via GEB and Macintosh blade conventional ETI [91.7% (44/48), 93.8% (45/48), respectively, p=1.000]. Use of GEB increased ETI time [28.6±6.0 sec vs. 17.1±4.0 sec, mean df: 11.3 sec (95% CI: 9.7-12.8), p<0.001]. While 87.6% of the practitioners evaluated the use of GEB as very easy and easy, 83.3% of the practitioners evaluated the traditional method as very easy and easy (p=0.914). Conclusion:GEB does not make any difference in pediatric airway management in terms of first-pass success. However, the use of GEB in terms of ETI durations increases the duration of ETI. Besides, the use of GEB is seen as a method that can be applied more efficiently, even in inexperienced groups.

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Section: Discussionmentioning

confidence: 71%

Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

Birinci¹,

Özerol²,

Divriklioğlu³

et al. 2022

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“…In contrast, a recent randomized clinical study showed that among emergency physicians, the use of a GEB resulted in a significantly shorter ETI time than the use of an endotracheal tube + stylet in patients with a difficult airway [13]. Other studies showed that the use of a GEB by anesthesiologists also reduced the ETI time in the operation room setting [39], simulated difficult airway in infants [40], and simulated cardiopulmonary resuscitation [41]. These discrepancies between our results and past studies can likely be explained by differences in clinical experience and training levels.…”

Section: Discussionmentioning

confidence: 98%

Lower maximum forces on oral structures when using gum-elastic bougie than when using endotracheal tube and stylet during both direct and indirect laryngoscopy by novices: a crossover study using a high-fidelity simulator

et al. 2020

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Background Applying excessive force during endotracheal intubation (ETI) is associated with several complications, including dental trauma and hemodynamic alterations. A gum-elastic bougie (GEB), a type of tracheal tube introducer, is a useful airway adjunct for patients with poor laryngoscopic views. However, how the use of a GEB affects the force applied during laryngoscopy is unclear. We compared the force applied on the oral structures during ETI performed by novices using the GEB versus an endotracheal tube + stylet. Methods This prospective crossover study was conducted from April 2017 to March 2019 in a public medical university in Japan. In total, 209 medical students (4th and 5th grade, mean age of 23.7 ± 2.0 years) without clinical ETI experience were recruited. The participants used either a Macintosh direct laryngoscope (DL) or C-MAC video laryngoscope (VL) in combination with a GEB or stylet to perform ETI on a high-fidelity airway management simulator. The order of the first ETI method was randomized to minimize the learning curve effect. The outcomes of interest were the maximum forces applied on the maxillary incisors and tongue during laryngoscopy. The implanted sensors in the simulator quantified these forces automatically. Results The maximum force applied on the maxillary incisors was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (39.0 ± 23.3 vs. 47.4 ± 32.6 N, P < 0.001) and C-MAC VL (38.9 ± 18.6 vs. 42.0 ± 22.1 N, P < 0.001). Similarly, the force applied on the tongue was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (31.9 ± 20.8 vs. 37.8 ± 22.2 N, P < 0.001) and C-MAC VL (35.2 ± 17.5 vs. 38.4 ± 17.5 N, P < 0.001). Conclusions Compared with the use of an endotracheal tube + stylet, the use of a GEB was associated with lower maximum forces on the oral structures during both direct and indirect laryngoscopy performed by novices. Our results suggest the expanded role of a GEB beyond an airway adjunct for difficult airways.

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“…There is a paucity of literature on TTI use in infant intubations, which is limited to case reports, use for airway exchange, simulation models with anesthesiologists, and clinical descriptive use by pediatric anesthesiologist for few pediatric intubations. [17][18][19][20][21][22][23][24] In our infant simulation study, the FPS with the use of the TTI was low. Multiple airway operators commented that the device's lack of rigidity made it too difficult to direct.…”

Section: Discussionmentioning

confidence: 99%

The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation

et al. 2022

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BackgroundPediatric emergency intubation is a high-acuity, low-occurrence procedure. Despite advances in technology, the success of this procedure remains low and adverse events are very high. Prospective observational studies in children have demonstrated improved success with the use of video laryngoscopy (VL) compared with direct laryngoscopy, although reported first-pass success (FPS) rates are lower than that reported for adults. This may in part be due to difficulty directing the tracheal tube to the laryngeal inlet considering the cephalad position of the larynx in infants. Using airway adjuncts such as the pediatric rigid stylet (PRS) or a tracheal tube introducer (TTI) may aid with intubation to the cephalad positioned airway when performing VL. The objectives of this study were to assess the FPS and time to intubation when intubating an infant manikin with a standard malleable stylet (SMS) compared with a PRS and TTI.MethodsThis was a randomized cross-over study performed at an academic institution both with emergency medicine (EM) and combined pediatric and EM (EM&PEDS) residency programs. Emergency medicine and EM&PEDS residents were recruited to participate. Each resident performed intubations on a 6-month-old infant simulator using a standard geometry C-MAC Miller 1 video laryngoscope and 3 different intubation adjuncts (SMS, PRS, TTI) in a randomized fashion. All sessions were video recorded for data analysis. The primary outcome was FPS using the 3 different intubation adjuncts. The secondary outcome was the mean time to intubation (in seconds) for each adjunct.ResultsFifty-one participants performed 227 intubations. First-pass success with the SMS was 73% (37/51), FPS was 94% (48/51) with the PRS, and 29% (15/51) with the TTI. First-pass success was lower with the SMS (−43%; 95% confidence interval [CI], −63% to −23%; P < 0.01) and significantly lower with the TTI compared with PRS (difference −65%; 95% CI, −81% to −49%; P < 0.01). First-pass success while using the PRS was higher than SMS (difference 22%, 7% to 36%; P < 0.01). The mean time to intubation using the SMS was 44 ± 13 seconds, the PRS was 38 ± 11 seconds, and TTI was 59 ± 15 seconds. The mean time to intubation was higher with SMS (difference 15 seconds; 95% CI, 10 to 20 seconds; P < 0.01) and significantly higher with the TTI compared with PRS (difference 21 seconds; 95% CI, 17 to 26 seconds; P < 0.01). Time to intubation with the PRS was lower than SMS (difference −7 seconds; 95% CI, −11 to −2 seconds; P < 0.01). The ease of use was significantly higher for the PRS compared with the TTI when operators rated them on a visual analog scale (91 vs 20 mm).ConclusionsUse of the PRS by EM and EM&PEDS residents on an infant simulator was associated with increased FPS and shorter time to intubation. Clinical studies are warranted comparing these intubation aids in children.

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Utility of a Gum-Elastic Bougie for Difficult Airway Management in Infants: A Simulation-Based Crossover Analysis

Cited by 12 publications

References 23 publications

Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

Comparison of Gum Elastic Bougie and Macintosh Laryngoscope in Pre-hospital Pediatric Airway Management; A Randomized, Prospective Study

Lower maximum forces on oral structures when using gum-elastic bougie than when using endotracheal tube and stylet during both direct and indirect laryngoscopy by novices: a crossover study using a high-fidelity simulator

The Pediatric Rigid Stylet Improves First-Pass Success Compared With the Standard Malleable Stylet and Tracheal Tube Introducer in a Simulated Pediatric Emergency Intubation

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