Early clinical experience with a new videolaryngoscope (GlideScope®) in 728 patients
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Abstract
Purpose
To evaluate a new videolaryngoscope and assess its ability to provide laryngeal exposure and facilitate intubation.
Methods
Five centres, involving 133 operators and a total of 728 consecutive patients, participated in the evaluation of a new videolaryngoscope [GlideScope® (GS)]. Many operators had limited or no previous GS experience. We collected information about patient demographics and airway characteristics, Cormack-Lehane (C/L) views and the ease of intubation using the GS. Failure was defined as abandonment of the technique.
Results
Data from six patients were incomplete and were excluded. Excellent (C/L 1) or good (C/L 2) laryngeal exposure was obtained in 92% and 7% of patients respectively. In all 133 patients in whom both GS and direct laryngoscopy (DL) were performed, GS resulted in a comparable or superior view. Among the 35 patients with C/L grade 3 or 4 views by DL, the view improved to a C/L 1 view in 24 and a C/L 2 view in three patients. Intubation with the GS was successful in 96.3% of patients. The majority of the failures occurred despite a good or excellent glottic view.
Conclusions
GS laryngoscopy consistently yielded a comparable or superior glottic view compared with DL despite the limited or lack of prior experience with the device. Successful intubation was generally achieved even when DL was predicted to be moderately or considerably difficult. GS was abandoned in 3.7% of patients. This may reflect the lack of a formal protocol defining failure, limited prior experience or difficulty manipulating the endotracheal tube while viewing a monitor.
Keywords
Tracheal Intubation Difficult Airway Direct Laryngoscopy Difficult Tracheal Intubation Laryngeal ViewExpérience clinique préliminaire avec un nouveau vidéolaryngoscope (GlideScope®) chez 728 patients
Résumé
Objectif
Évaluer un nouveau vidéolaryngoscope et tester sa capacité à fournir une exposition du larynx et à faciliter l’intubation.
Méthode
Cinq centres, impliquant 133 opérateurs et 728 patients consécutifs, ont participé à l’évaluation du nouveau vidéolaryngoscope [GlideScope® (GS)]. De nombreux opérateurs avaient une expérience nulle ou limitée du GS. Nous avons noté les données démographiques et les caractéristiques des voies aériennes, la classification Cormack-Lehane (C/L) des visualisations et la facilité à intuber avec le GS. Un échec était défini comme un abandon de la technique. Résultats: Six patients ont été exclus à cause de données incomplètes. Une excellente (C/L 1) ou une bonne (C/L 2) exposition du larynx a été obtenue chez 92 % et 7 % des patients respectivement. Chez les 133 patients soumis aux deux tests avec le GS et à la laryngoscopie directe (LD), le GS a donné des résultats comparables ou une vue supérieure. Parmi les 35 patients avec un grade 3 ou 4 de C/L par LD, la visualisation s’est améliorée à 1 C/L chez 24 patients et à 2 C/L chez trois patients. L’intubation avec le GS a été réussie chez 96,3 % des patients. La majorité des échecs sont survenus malgré une bonne ou une excellente visualisation glottique.
Conclusion
La laryngoscopie avec le GS fournit toujours une vision glottique comparable ou supérieure à la LD malgré l’expérience nulle ou limitée avec l’appareil. L’intubation a été généralement réussie même lorsqu’on prévoyait une difficulté modérée ou importante de la LD. Le GS a été abandonné chez 3,7 % des patients. Cela pourrait correspondre au manque de protocole formel définissant l’échec, à l’expérience antérieure limitée ou à la difficulté de manipuler le tube endotrachéal tout en surveillant l’écran.
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