The Evaluation of a Better Intubation Strategy When Only the Epiglottis Is Visible

A Randomized, Cross-over Mannequin Study

Tzu-Yao Hung; Li-Wei Lin; Yu-Hang Yeh; Yung-Cheng Su; Chieh-Hung Lin; Ten-Fang Yang

Disclosures

BMC Anesthesiol. 2019;19(8) 

In This Article

Results

Table 1 shows the distribution of sex, class, height, and duration of practice in the emergency department of the 32 participants. Of the 32 participants, 26, 4, and 4, were attending physicians, residents, and nurse practitioners, respectively. After the video clips were reviewed, 96.87% of glottis views were C-L grade III, and the rest were grade IIb. The overall success rate of the intubation was 95.63%. The duration of the intubation with holding top of banana shape stylets with 28 cm and 26 cm longitudinal distance, holding middle of banana shape stylets with 28 cm and 26 cm longitudinal distance, holding top of straight-to-cuff with 35 degrees and 50 degrees bend angles, holding top of straight-to-cuff with 35 degrees and 50 degrees bend angles were 33.63 ± 33.87 s, 31.91 ± 31.82 s, 30.10 ± 18.73 s, 31.06 ± 24.59 s, 34.81 ± 27.70 s, 28.03 ± 16.36 s, 34.10 ± 32.12 s, 27.53 ± 16.31 s, 23.75 ± 14.24 s, 20.72 ± 6.90 s, respectively; the success rate were 90.63, 93.75, 96.88, 93.75, 93.75, 96.88, 93.75, 96.88, 100, 100%, respectively; the VAS scores were 4.24 ± 2.11 cm, 4.34 ± 2.33 cm, 4.62 ± 1.94 cm, 4.48 ± 2.12 cm, 4.67 ± 2.30 cm, 4.36 ± 2.32 cm, 4.29 ± 4.48 cm, 3.90 ± 2.12 cm, 4.15 ± 2.22 cm, 3.97 ± 2.13 cm, respectively (Table 2).

A Kaplan-Meier plot (Figure 3) illustrates a significantly shorter time to successful intubation with the two subgroups that performed lifting of the epiglottis with stylets (23.75 ± 14.24 s and 20.72 ± 6.90 s among bend angles of 35° and 50°, respectively) and 100% success rate of intubation. In the Cox regression analysis, only the lifting of the epiglottis was significant (p < 0.0001, Table 3).

Figure 3.

Kaplan–Meier failure estimate for different intubation postures: lifting the epiglottis was more successful than holding the top or middle of the endotracheal tube (p < 0.001)

Based on the results from logistic and linear regression models, VAS was strongly related to intubation time. For each 1 cm increase in the VAS, the odds ratio of success was increased by 0.55, and the intubation time increased by 3.77 s. (Table 2 and Table 3, respectively).

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