Methods to Improve Success With the GlideScope Video Laryngoscope

Occasionally intubation of patients is difficult using a video laryngoscope (GlideScope, Verathon Medical) because of an inability to guide the endotracheal tube to the glottis or pass the tube into the trachea despite an adequate view of the glottis. We examined methods to improve success when this difficulty occurs. A literature search revealed 253 potential sources, with 25 meeting search criteria: 7 randomized controlled trials, 4 descriptive studies, 8 case series, and 6 case reports. Findings from the randomized controlled trials suggested that using a flexible-tipped endotracheal tube with a rigid stylet (GlideRite, Verathon Medical) improved intubation success, whereas other methods did not, such as using a forceps-guided endotracheal tube exchanger. If a malleable stylet was used, a 90 degrees bend above the endotracheal tube cuff was preferable to a 60 degrees bend. Evidence from lower-level sources suggested that several interventions were helpful, including using a controllable stylet, a fiberoptic bronchoscope in conjunction with the GlideScope, or an intubation guide, and twisting the endotracheal tube to facilitate passage into the trachea. Providers must consider the risks and benefits of any technique, particularly if the device manufacturer does not recommend the technique. Further rigorous investigations should be conducted examining methods to increase success.