Videolaryngoscopy with hyperangled vs. Macintosh-shaped blades
Brooke Harris, BSN
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The use of VLs for routine orotracheal OR intubation has gained popularity due to excellent glottic visualization, minimal cervical manipulation, and a high first-pass intubation success rate. However, despite clear benefits, reports of soft palate and tonsillar pillar injuries with VL use have increased, particularly with hyperangulated VL blades such as the GlideScope. These injuries may be associated with seemingly smooth intubations and are often unrecognized until after successful intubation or surgery completion.
When available and appropriate, using a Macintosh-shaped VL blade over a hyperangulated VL blade may result in less airway trauma. If a hyperangulated VL blade is used, alternating standard practice is vital to optimizing patient safety with its use. For example, using a flexible stylet or fiberscope with GlideScope intubations results in decreased time to successful intubation with significantly fewer airway injuries than a rigid stylet. In addition to stylet modifications, reinforced ETTs such as the BlockBuster ETT are associated with decreased incidence of injury with VL use versus intubation with a standard ETT. Recognizing predictors of difficult ETT passage with VL may allow for an adjusted approach to improve success and decrease complications. For example, a short thyromental distance and limited jaw protrusion may contribute to difficult ETT passage with the GlideScope due to a disproportionate oropharynx and limited space for the tube and blade in the oral cavity. In these patients, a smaller VL blade and a gum elastic bougie may improve intubation success and lessen contact with the patient’s oral mucosa. More large-scale, high-quality studies are needed to quantify the incidence of airway trauma in OR intubations with hyperangulated blades versus Macintosh-shaped VL blades
|Type||DNP Capstone Project|
|Review Type||None: Degree-based Submission|
|Evidence Level||Case Study/Series|
|Research Approach||Translational Research/Evidence-based Practice|
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