Background information: There are two popular blade shapes for video laryngoscopy, a standard-geometry blade comparable to a Macintosh blade and a hyperangulated blade. The standard-geometry blade permits both direct and indirect visualization during intubation, whereas the hyperangulated blade permits only indirect visualization. The hyperangulated blade is used with a rigid stylet, whereas the standard-geometry blade allows the use of a bougie if indicated.Proposed benefits of the hyperangulated blade include decreasing the need for head and neck manipulation. Previous research includes an observational study using emergency department data that compared the two blade shapes found no association between blade geometry and first-attempt success rates (Moiser et al.), but this was a single-center study with only 463 patients. Previous unadjusted data from the registry used in the current study by Driver et al. found that standard-geometry video laryngoscopy had a higher first-attempt success rate than video laryngoscopy using the hyperangulated blade (91 percent versus 80 percent, n=1,644) based on data from 2002 through 2012 (Brown et al.)....Read More
Background:Endotracheal intubation is a common occurrence in the ED. Many patients requiring airway management are at a higher risk of hypoxia due to deranged respiratory physiology (i.e. decreased functional residual capacity and/or increased shunt fraction). Advocates of video laryngoscopy argue that it provides better visualization of the airway anatomy, but it is less clear if better visualization correlates with better patient oriented outcomes. Good preparation, pre-oxygenation, and having a plan A, B, and C prior to intubation are essential requirements in 1st pass intubation success rate and decreased intubation time. What is less clear is should plan A be VL or DL?...Read More
According to a 2012 meta-analysis difficult and failed intubations in the operating room occur 1.8 - 5.8% and 0.13 - 0.30% of the time respectively. Emergent intubation, outside of this environment (i.e emergency department, ICU, and medical ward) is typically associated with a much higher risk of difficulty and complications due to many patients rapidly deteriorating. Recently, I had a discussion on twitter with Jeffrey Hill (@_drjeffy) and Taylor Zhou (@canibagthat) about what is the best way to teach trainees to intubate: Video Laryngoscopy (VL) or Direct Laryngoscopy (DL) for Trainees?