Flexible Intubation Scope versus Flexible Intubation Scope and Video Laryngoscopy Combination: A Prospective...

Area of Science:

• Anesthesiology
• Airway Management
• Medical Devices

Background:

• Suboptimal airway management in patients with anticipated difficult airways can lead to increased perioperative morbidity and mortality.
• Combining video laryngoscopy (VL) with a flexible intubation scope (FIS) may improve visualization and endotracheal tube (ETT) passage.
• Limited randomized evidence currently supports the combined FIS/VL approach for difficult airways.

Purpose of the Study:

• To evaluate the effectiveness of a combined flexible intubation scope with video laryngoscopy (FIS/VL) compared to flexible intubation scope (FIS) alone for endotracheal intubation in adults with anticipated difficult airways.
• To assess the composite rate of difficult ETT placement, including intubation time, first-attempt failure, and provider-rated difficulty.
• To analyze secondary outcomes such as total intubation time and provider-rated ease of intubation.

Main Methods:

• A prospective, randomized trial involving 135 adult patients with anticipated difficult airways undergoing elective surgery.
• Patients were randomized 1:1 to intubation with either FIS alone or the combined FIS/VL technique.
• The primary endpoint was the composite rate of difficult ETT placement; secondary outcomes included total intubation time and provider-rated ease of intubation.

Main Results:

• The first-pass success rate was significantly higher in the FIS/VL group (93.1%) compared to the FIS group (78.1%) (P = .020).
• Provider-rated difficult or unsuccessful intubations were less frequent with FIS/VL (6.1%) versus FIS (19.4%) (P = .025).
• The composite primary endpoint of difficult ETT placement did not significantly differ between the groups (45.9% for FIS/VL vs. 59.7% for FIS; P = .118).

Conclusions:

• In adults with anticipated difficult airways, the addition of VL to FIS did not significantly reduce the composite rate of difficult endotracheal tube placement.
• The combined FIS/VL technique was associated with improved first-pass success rates and fewer provider-rated difficult/unsuccessful intubations.
• Dual-visualization strategies show clinical value for improving first-pass performance, but larger trials are needed to confirm effects on composite difficulty endpoints.