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The Importance of Median Glossoepiglottic Fold Engagement on Laryngeal View and Tracheal Intubation Success in

Preston Dean1, Katherine Edmunds1, Ashish Shah2

  • 1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

Annals of Emergency Medicine
|February 16, 2023
PubMed

Insights

Directly lifting the epiglottis during pediatric tracheal intubation significantly improves glottic visualization. Engaging the median glossoepiglottic fold in the vallecula further enhances visualization and procedural success.

Area of Science:

  • Pediatric Emergency Medicine
  • Anesthesiology
  • Airway Management

Background:

  • Tracheal intubation in children presents unique airway challenges.
  • Laryngoscope blade tip placement is a critical factor influencing intubation success.
  • Optimizing glottic visualization is key to successful pediatric intubation.

Purpose of the Study:

  • To investigate the association between laryngoscope blade tip placement and tracheal intubation outcomes in pediatric patients.
  • To compare direct epiglottic lifting versus vallecula placement.
  • To evaluate the impact of median glossoepiglottic fold engagement on intubation success.

Main Methods:

  • Video-based observational study of pediatric emergency department intubations.
  • Utilized standard geometry Macintosh and Miller video laryngoscope blades.
  • Analyzed blade tip placement (vallecula vs. direct lift) and glossoepiglottic fold engagement as exposures.
  • Assessed glottic visualization (percentage of glottic opening, modified Cormack-Lehane) and procedural success as outcomes.

Main Results:

  • Blade tip placement in the vallecula (indirect lift) occurred in 71.9% of attempts.
  • Directly lifting the epiglottis significantly improved glottic visualization (POGO, modified Cormack-Lehane) compared to indirect lifting.
  • Engagement of the median glossoepiglottic fold in the vallecula was associated with improved POGO, modified Cormack-Lehane, and procedural success.

Conclusions:

  • Pediatric tracheal intubation can be achieved with high success using direct or indirect epiglottic lifting techniques.
  • When using indirect lifting (vallecula placement), engaging the median glossoepiglottic fold is crucial for maximizing glottic visualization and procedural success.
Abstract

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