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      Using King Vision video laryngoscope with a channeled blade prolongs time for tracheal intubation in different training levels, compared to non-channeled blade

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      Author(s): 1 , 1 , 2 , *
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      Publication date (Electronic):
      Journal: PLoS ONE
      Publisher: Public Library of Science

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          Abstract

          Purpose

          It is generally accepted that using a video laryngoscope is associated with an improved visualization of the glottis. However, correctly placing the endotracheal tube might be challenging. Channeled video laryngoscopic blades have an endotracheal tube already pre-loaded, allowing to advance the tube once the glottis is visualized. We hypothesized that use of a channel blade with pre-loaded endotracheal tube results in a faster intubation, compared to a curved Macintosh blade video laryngoscope.

          Methods

          After ethical approval and informed consent, patients were randomized to receive endotracheal Intubation with either the King Vision ® video laryngoscope with curved blade (control) or channeled blade (channeled). Success rate, evaluation of the glottis view (percentage of glottic opening (POGO), Cormack&Lehane (C&L)) and intubating time were evaluated.

          Results

          Over a two-month period, a total of 46 patients (control n = 23; channeled n = 23) were examined. The first attempt success rates were comparable between groups (control 100% (23/23) vs. channeled 96% (22/23); p = 0.31). Overall intubation time was significantly shorter with control (median 40 sec; IQR [24–58]), compared to channeled (59 sec [40–74]; p = 0.03). There were no differences in glottis visualization between groups.

          Conclusion

          Compared with the King Vision channeled blade, time for tracheal intubation was shorter with the control group using a non-channeled blade. First attempt success and visualization of the glottis were comparable. These data do not support the hypothesis that a channeled blade is superior to a curved video laryngoscopic blade without tube guidance.

          Trial registration

          ClinicalTrials.gov NCT02344030

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          Most cited references32

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          Difficult tracheal intubation in obstetrics.

          R Cormack, J. Lehane (1984)
          Difficult intubation has been classified into four grades, according to the view obtainable at laryngoscopy. Frequency analysis suggests that, in obstetrics, the main cause of trouble is grade 3, in which the epiglottis can be seen, but not the cords. This group is fairly rare so that a proportion of anaesthetists will not meet the problem in their first few years and may thus be unprepared for it in obstetrics. However the problem can be simulated in routine anaesthesia, so that a drill for managing it can be practised. Laryngoscopy is carried out as usual, then the blade is lowered so that the epiglottis descends and hides the cords. Intubation has to be done blind, using the Macintosh method. This can be helpful as part of the training before starting in the maternity department, supplementing the Aberdeen drill.
          Article 0 comments Cited 188 times – based on 0 reviews     Review now
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            Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients.

            Stuart A McCluskey, Kyle Bishop, Allan A Pacey … (2005)
            To evaluate a new videolaryngoscope and assess its ability to provide laryngeal exposure and facilitate intubation. Five centres, involving 133 operators and a total of 728 consecutive patients, participated in the evaluation of a new video-laryngoscope [GlideScope (GS)]. Many operators had limited or no previous GS experience. We collected information about patient demographics and airway characteristics, Cormack-Lehane (C/L) views and the ease of intubation using the GS. Failure was defined as abandonment of the technique. Data from six patients were incomplete and were excluded. Excellent (C/L 1) or good (C/L 2) laryngeal exposure was obtained in 92% and 7% of patients respectively. In all 133 patients in whom both GS and direct laryngoscopy (DL) were performed, GS resulted in a comparable or superior view. Among the 35 patients with C/L grade 3 or 4 views by DL, the view improved to a C/L 1 view in 24 and a C/L 2 view in three patients. Intubation with the GS was successful in 96.3% of patients. The majority of the failures occurred despite a good or excellent glottic view. GS laryngoscopy consistently yielded a comparable or superior glottic view compared with DL despite the limited or lack of prior experience with the device. Successful intubation was generally achieved even when DL was predicted to be moderately or considerably difficult. GS was abandoned in 3.7% of patients. This may reflect the lack of a formal protocol defining failure, limited prior experience or difficulty manipulating the endotracheal tube while viewing a monitor.
            Article 0 comments Cited 94 times – based on 0 reviews     Review now
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              Assessment of airway visualization: validation of the percentage of glottic opening (POGO) scale.

              S Kush, E A Ochroch, E Andrew Ochroch … (1998)
              Research defining optimal methods of intubation has been limited by the lack of a validated outcome measure to assess airway visualization. The objective of this study was to develop a reliable scale for the assessment of airway visualization during endotracheal intubation. This prospective study was performed to assess the intra- and interphysician reliabilities of emergency physicians (EPs) for estimating the percentage of glottic opening (POGO) that is visualized during direct laryngoscopy. Using video images of laryngeal views obtained from a commercially available videotape, still slide images were prepared representing glottic openings ranging from 0% to 100%. Five EPs, blinded to study objective, reviewed 25 pairs of airway slides (50 slides total). For each slide, the physicians recorded the POGO and their scores using a modified Cormack-Lehane (MCL) scale, where grade I is a view of the full glottic opening, MCL grade II is a partial view of the glottic opening, and MCL grade III is a view of the epiglottis only. Inter- and intraphysician reliabilities were assessed using the kappa statistic (K) for MCL grade and intraclass correlation coefficient for the POGO scores. For the POGO score, the degree of intrarater reliability was very good, with an intraphysician correlation of 0.85 and an interphysician correlation of 0.74. For the MCL score, the intraphysician concordance had a K of 0.71, and interphysician concordance was also good, with a kappa of 0.59. Both the modified version of the Cormack-Lehane grading classification and the POGO score have good interphysician and intraphysician reliabilities. Because the POGO score can distinguish patients with large and small degrees of partial glottic visibility, it might provide a better outcome for assessing the difference between various intubation techniques.
              Article 0 comments Cited 79 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Marc Kriege: Role: Data curationRole: Writing – original draftRole: Writing – review & editing
                Christian Alflen: Role: ValidationRole: Writing – review & editing
                Ruediger R. Noppens:
                ORCID: http://orcid.org/0000-0003-0069-579X
                Role: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                André A. J. Van Zundert: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 31 August 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 8
                Electronic Location Identifier: e0183382
                Affiliations
                [1 ] Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
                [2 ] Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
                University of Queensland, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-0069-579X
                Article
                Publisher ID: PONE-D-16-36572
                DOI: 10.1371/journal.pone.0183382
                PMC ID: 5578637
                PubMed ID: 28859114
                SO-VID: 3083ce17-7a25-4e49-9940-d28ea42057fe
                Copyright © © 2017 Kriege et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 19 September 2016
                Date accepted : 2 August 2017
                Page count
                Figures: 4, Tables: 1, Pages: 12
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Intubation
                Subject: Medicine and Health Sciences
                Subject: Anesthesiology
                Subject: Anesthesia
                Subject: Medicine and Health Sciences
                Subject: Pharmaceutics
                Subject: Drug Therapy
                Subject: Anesthesia
                Subject: Biology and Life Sciences
                Subject: Neuroscience
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                Subject: Learning
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                Subject: Learning
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                Subject: Psychology
                Subject: Cognitive Psychology
                Subject: Learning
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                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Learning and Memory
                Subject: Learning
                Subject: Learning Curves
                Subject: Medicine and Health Sciences
                Subject: Anesthesiology
                Subject: Anesthesia
                Subject: General Anesthesia
                Subject: Medicine and Health Sciences
                Subject: Pharmaceutics
                Subject: Drug Therapy
                Subject: Anesthesia
                Subject: General Anesthesia
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                Subject: Anesthesiology
                Subject: Anesthesia
                Subject: Local and Regional Anesthesia
                Subject: Neuromuscular Blockade
                Subject: Medicine and Health Sciences
                Subject: Pharmaceutics
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                Subject: Local and Regional Anesthesia
                Subject: Neuromuscular Blockade
                Subject: Medicine and Health Sciences
                Subject: Critical Care and Emergency Medicine
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