Failure Rates for Endotracheal Tube Placement Using Videolaryngoscopy in Patients with a Difficult Airway.

Area of Science:

• Anesthesiology
• Airway Management
• Critical Care Medicine

Background:

• Videolaryngoscopy (VL) has transformed airway management by offering improved glottic visualization compared to direct laryngoscopy (DL).
• However, the indirect view provided by VL can complicate endotracheal tube (ETT) manipulation, potentially requiring adjuncts.

Purpose of the Study:

• To investigate the necessity of additional airway aids (bougie or fiberoptic scope) for endotracheal tube placement during VL in patients with difficult airways.
• To evaluate the effectiveness of VL in improving glottic views and facilitating intubation in challenging cases.

Main Methods:

• A retrospective observational study analyzing data from 165 patients with difficult airways (defined as Cormack and Lehane [C&L] grade 3 or 4 using DL).
• Assessment of ETT placement success with and without adjuncts, and the role of bougie and fiberoptic scopes in VL-guided intubation.

Main Results:

• Simple ETT placement without adjuncts occurred in only 20.6% of patients.
• Nearly 80% (131 patients) required a bougie or fiberscope for successful ETT placement.
• Fiberscope-assisted VL was successful in all 33 patients where bougie-only placement failed. VL significantly improved C&L grades for both grade 3 and 4 views.

Conclusions:

• While VL significantly enhances glottic visualization in difficult airways, it frequently necessitates the use of adjuncts like bougies or fiberscopes for successful endotracheal tube placement.
• Clinicians using VL should anticipate the need for additional airway devices, as improved views do not always guarantee straightforward intubation.
• Fiberscope-assisted VL provides a viable rescue strategy when initial attempts with VL and bougie are unsuccessful.