Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Anesthesiol. Mar 27, 2018; 7(1): 1-9
Published online Mar 27, 2018. doi: 10.5313/wja.v7.i1.1
Change in management of predicted difficult airways following introduction of video laryngoscopes
Mary Jarzebowski, Arvind Rajagopal, Bryce Austell, Mario Moric, Asokumar Buvanendran
Mary Jarzebowski, Arvind Rajagopal, Bryce Austell, Mario Moric, Asokumar Buvanendran, Department of Anesthesiology, Rush University Medical Center, Chicago, IL 60612, United States
Author contributions: Jarzebowski M and Rajagopal A designed the study; Jarzebowski M and Austell B performed the data collection; Moric M provided the statistical analysis; Jarzebowski M and Austell B wrote the manuscript with oversight and input from Rajagopal A and Buvanendran A; Jarzebowski M and Austell B performed edits on the manuscript; Austell B submitted the manuscript and all accompanying documents.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Rush University Medical Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bryce Austell, MD, Doctor, Department of Anesthesiology, Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL 60612, United States. bryce_t_austell@rush.edu
Telephone: +312-9425000 Fax: +312-9428858
Received: December 4, 2017
Peer-review started: December 5, 2017
First decision: December 18, 2017
Revised: December 24, 2017
Accepted: January 16, 2018
Article in press: January 16, 2018
Published online: March 27, 2018
ARTICLE HIGHLIGHTS
Research background

Advanced techniques and equipment are often needed for tracheal intubation in patients with difficult airways. New technology has brought about video laryngoscopes (VLs). Multiple studies have compared VL to direct laryngoscopy and the effects on success rates and factors surrounding intubation. However, in this study we aim to investigate the influence of VL on fiberoptic intubation, the previous gold standard for difficult airways.

Research motivation

Management of the difficult airway has traditionally relied on the difficult airway algorithm published by the American Society of Anesthesiologists. Given the ever-increasing clinical use of VL, it is important to assess if their introduction has affected the clinical practice of managing difficult airways, specifically in regards to awake fiberoptic intubation, part of the difficult airway algorithm.

Research objectives

In light of the introduction of VL, this study investigates whether or not the rate of awake fiberoptic intubation has decreased in the management of difficult airway. It is important to recognize the trends surrounding VL given that the frequency of use and level of training that anesthetists have with fiberoptic intubation may be influenced. If this were the case it would be important to acknowledge and address in the future.

Research methods

Anesthetic records were reviewed at Rush University Medical Center before and after the introduction of video laryngoscopes to analyze the effects on awake fiberoptic intubation (FOI).

Research results

Awake FOI decreased from 13.1% before VL to 9% after video laryngoscopy (P = 0.1768 but trended toward significance). Morbid obesity (larger BMI P = 0.0154, OR = 1.5 per 10-point BMI increase), male gender (P = 0.0026, OR = 3.0), and higher el-Ganzouri score (P = 0.0007, OR = 1.5) predicted higher rates of awake FOI. VL was used to intubate 51% of predicted difficult airways, while use of direct laryngoscopy significantly decreased.

Research conclusions

In light of increasing use of VL, fiberoptic intubation remains the gold standard for difficult airway intubation. It is important for patient safety that our specialty commit to train on multiple modalities of tracheal intubation in order to be prepared for the most difficult of airways. Continued study is required to assess trends in regards to VL vs fiberoptic intubation in difficult airways.

Research perspectives

While a retrospective study has shed light on the fact that the rate of VL is clearly increasing, a randomized clinical trial could provide greater data on the outcomes of difficult airways given varying tracheal intubation methods. In addition, continual readdressing of VL use in difficult airways will aid in assessing whether or not it should be introduced into the difficult airway algorithm.