Applied forces with direct versus indirect laryngoscopy in neonatal intubation: a randomized crossover mannequin...

Area of Science:

• Medical Devices
• Anesthesiology
• Pediatric Care

Background:

• Direct laryngoscopy is a common intubation technique.
• Videolaryngoscopy offers improved glottic visualization in adults.
• The application of force during neonatal intubation is a concern for patient safety.

Purpose of the Study:

• To compare oropharyngeal applied forces and subjective workload during direct versus indirect (video) laryngoscopy in a neonatal mannequin.
• To evaluate the efficacy of different videolaryngoscopy devices in a simulated neonatal airway.

Main Methods:

• A randomized crossover trial was conducted using a neonatal mannequin.
• Thirty consultants and residents performed intubations using direct laryngoscopy, straight blade videolaryngoscopy, and hyperangulated videolaryngoscopy.
• Primary outcome was maximum peak force; secondary outcomes included average peak force, intubation time, and subjective workload.

Main Results:

• Direct laryngoscopy resulted in significantly higher median peak forces (8.2 N max, 6.8 N avg) compared to straight blade (4.7 N max, 3.6 N avg) and hyperangulated (2.8 N max, 2.1 N avg) videolaryngoscopy.
• Significant differences in forces were observed on the epiglottis and palate.
• Intubation time and subjective workload were comparable across all methods.

Conclusions:

• Videolaryngoscopy, particularly hyperangulated types, applies significantly less force to airway tissues in a neonatal mannequin model.
• This reduction in force suggests a potential benefit for minimizing patient harm during neonatal intubation.
• Further clinical studies are necessary to confirm these findings and assess real-world implications.