Unlabelled: Tracheal intubation (TI) is a common procedure in critical care, often performed with a Macintosh curved blade used for direct laryngoscopy (DL). Minimal evidence informs the choice between Macintosh blade sizes during TI. We hypothesized that Macintosh 4 blade would have higher first-attempt success than Macintosh 3 blade during DL.
Design: Retrospective analysis using a propensity score and inverse probability weighting of data from six prior multicenter randomized trials.
Setting And Participants: Adult patients who underwent nonelective TI at participating emergency departments and ICUs. We compared the first-pass success of TI with DL in subjects intubated with a size 4 Macintosh blade on the first TI attempt to subjects with a size 3 Macintosh blade on the first TI attempt.
Main Results: Among 979 subjects, 592 (60.5%) had TI using DL with a Macintosh blade, of whom 362 (37%) were intubated with a size 4 blade and 222 (22.7%) with a size 3 blade. We used inverse probability weighting with a propensity score for analyzing data. We found that patients intubated with a size 4 blade had a worse (higher) Cormack-Lehane grade of glottic view than patients intubated with a size 3 blade (adjusted odds ratio [aOR], 1.458; 95% CI, 1.064-2.003; = 0.02). Patients intubated with a size 4 blade had a lower first pass success than those with a size 3 blade (71.1% vs 81.2%; aOR, 0.566; 95% CI, 0.372-0.850; = 0.01).
Conclusions And Relevance: In critically ill adults undergoing TI using DL with a Macintosh blade, patients intubated using a size 4 blade on first attempt had a worse glottic view and a lower first pass success than patients intubated with a size 3 Macintosh blade. Further prospective studies are needed to examine the optimal approach to selecting laryngoscope blade size during TI of critically ill adults.
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http://dx.doi.org/10.1097/CCE.0000000000000855 | DOI Listing |
Indian J Anaesth
November 2024
Department of Radiodiagnosis, Christian Medical College, Ludhiana, Punjab, India.
Background And Aims: El-Ganzouri risk index (EGRI) scoring is a predictive tool for difficult video laryngoscope (VL) guided tracheal intubation, and its use has been studied for various VLs. This study evaluates the predictive value of EGRI scoring for difficult laryngoscopy and tracheal intubation with King Vision VL.
Methods: Airway assessment was performed preinduction using the EGRI score.
Anaesthesia
November 2024
Outcomes Research Consortium, Houston, TX, USA.
Introduction: The number of tracheal intubation attempts required to reach proficiency in videolaryngoscopy with hyperangulated blades is unknown. Understanding this training requirement might guide training for clinicians who perform laryngoscopy. We therefore performed a planned sub-analysis of a randomised controlled trial comparing tracheal intubation success with videolaryngoscopy vs.
View Article and Find Full Text PDFJ Perioper Pract
November 2024
Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India.
BMC Anesthesiol
November 2024
Department of Anesthesiology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No.69, Guizi Rd., Taishan Dist., New Taipei City 24352, Taiwan.
Background: Postoperative sore throat (POST) is a common complaint after general anesthesia. POST is defined by the presence of a self-reported foreign body sensation or a painful sensation in the throat after general anesthesia. This condition may affect recovery and patient satisfaction and is associated with many factors, including intubation tools.
View Article and Find Full Text PDFCan J Anaesth
October 2024
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Purpose: Applying a cervical collar during videolaryngoscopic intubation can increase the lifting force required to achieve adequate glottic view, potentially increasing cervical spine motion. We aimed to compared cervical spine motion during videolaryngoscopic intubation between applying only the posterior piece (posterior-only group) and applying both the anterior and posterior pieces (anterior-posterior group) in patients wearing a cervical collar.
Methods: We conducted a dingle-centre, parallel-group, randomized controlled trial in 102 patients (each group, N = 51).
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