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Video Versus Direct Laryngoscopy for Initial Trauma Airway Management: Is There a Winner?

  • Anesthesia for Trauma (TE Grissom, Section Editor)
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Abstract

Purpose of Review

Intubation of patients suffering acute traumatic injuries is associated with higher airway-related morbidity and mortality than when the same procedure occurs under elective conditions. Indirect video-enabled laryngoscopes (VL) offer the potential advantage of improved glottic visualization as an integral step in the process of endotracheal intubation when compared to traditional direct laryngoscopy (DL). However, despite robust evidence that VL consistently achieves a superior view of the vocal cords in critically ill and injured adults, a consistent improvement in first-attempt intubation success has not yet been demonstrated.

Recent Findings

A review of recent literature suggests that the primary limitations of VL in urgent airway management include steps subsequent to sighting, such as tube delivery and cannulation of the trachea; these are distinct, non-intuitive motor skills that require extensive, device-specific training to master. This has been demonstrated across acute care settings, including the prehospital environment, the emergency department, and the intensive care unit.

Summary

Given the spectrum of health care personnel who may be responsible for urgent airway management in trauma care, training programs should focus on high-volume opportunities to practice device-specific motor skills to improve the successful use of VL in acute care settings. Innovative stylet and/or tube technology may further optimize tube delivery and tracheal cannulation.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Correspondence to Aaron M. Joffe.

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Kelly K. Everhart declares that she has no conflict of interest.

Steven G. Venticinque has a patent pending has a patent pending for an intubating stylet to be used during video-assisted intubations.

Aaron M. Joffe declares that he has no conflict of interest.

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Everhart, K.K., Venticinque, S.G. & Joffe, A.M. Video Versus Direct Laryngoscopy for Initial Trauma Airway Management: Is There a Winner?. Curr Anesthesiol Rep 8, 78–85 (2018). https://doi.org/10.1007/s40140-018-0256-7

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