Video laryngoscopy: Difference between revisions
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==Overview== | ==Overview== | ||
[[File:Glidescope.png|thumb|Hyperangulated blade and rigid stylet typical of the Glidescope video laryngoscope]] | |||
[[File:CMAC.png|thumb|The C-MAC video laryngoscope (pictured above) has a Macintosh or "standard geometry" blade similar to that of a Macintosh [[Direct laryngoscopy|direct laryngoscope]] (pictured below)]] | |||
*Two most common devices are the C-MAC and the Glidescope | |||
** | **Both CMAC and Glidescope systems offer both hyperangulated and standard geometry blades | ||
*Increasingly utilized in emergency airway management<ref>Brown CA 3rd, Bair AE, Pallin DJ, Walls RM; NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations [published correction appears in Ann Emerg Med. 2017 May;69(5):540]. Ann Emerg Med. 2015;65(4):363-370.e1. doi:10.1016/j.annemergmed.2014.10.036</ref> | *Increasingly utilized in emergency airway management<ref>Brown CA 3rd, Bair AE, Pallin DJ, Walls RM; NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations [published correction appears in Ann Emerg Med. 2017 May;69(5):540]. Ann Emerg Med. 2015;65(4):363-370.e1. doi:10.1016/j.annemergmed.2014.10.036</ref> | ||
==Indications== | ==Indications== | ||
*Any patient requiring [[intubation]] | *Any patient requiring [[intubation]] | ||
*Particularly useful in patients with known or anticipated [[Predicting the difficult airway|difficult intubation]] | |||
==Contraindications== | ==Contraindications== | ||
*No absolute contraindications | |||
*Relative: | *Relative: | ||
**Blood or emesis in airway | **Blood or emesis in airway | ||
| Line 21: | Line 22: | ||
==Procedure== | ==Procedure== | ||
*Hyperangulated | *Hyperangulated video laryngoscope | ||
**Patient ideally in neutral spine position (as opposed to "sniffing" position for direct laryngoscopy) | **Patient ideally in neutral spine position (as opposed to "sniffing" position for direct laryngoscopy) | ||
**After induction, use right hand to "scissor" mouth open | **After induction, use right hand to "scissor" mouth open | ||
**Place hyperangulated blade midline and slowly advance with progressive identification of airway landmarks | **Place hyperangulated blade midline and slowly advance with progressive identification of airway landmarks | ||
**Advance blade into vallecula | **Advance blade into vallecula | ||
**When cords fill entire screen (Cormack-Lehane Grade I), slightly retract laryngoscopy so that cords only occupy upper 1/3 of screen (CL Grade II, allows for passage of ETT with rigid stylet) | **When cords fill entire screen (Cormack-Lehane Grade I), slightly retract laryngoscopy so that cords only occupy upper 1/3 of screen (CL Grade II, allows for passage of ETT with rigid stylet)<ref>Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Une vue laryngée délibérément restreinte à l'aide du vidéolaryngoscope GlideScope® est associée à une intubation trachéale plus rapide et plus aisée qu'une vue glottique totale: une étude clinique randomisée. Can J Anaesth. 2016;63(8):928-937. doi:10.1007/s12630-016-0654-6</ref> | ||
***If intubation is attempted with the best view possible, operators often have difficulty advancing the tube around the tongue and hypopharyngeal soft tissues | ***If intubation is attempted with the best view possible, operators often have difficulty advancing the tube around the tongue and hypopharyngeal soft tissues | ||
*Standard | *Standard geometry video laryngoscope | ||
**Same technique utilized with [[Direct laryngoscopy|direct laryngoscopy]] | **Same technique utilized with [[Direct laryngoscopy|direct laryngoscopy]] | ||
**Can either visualize directly or utilize video screen for tube delivery | **Can either visualize directly or utilize video screen for tube delivery | ||
| Line 67: | Line 68: | ||
*Post-intubation | *Post-intubation | ||
**[[Mechanical ventilation (main)]] | **[[Mechanical ventilation (main)]] | ||
**[[Deterioration after intubation]] ( | **[[Deterioration after intubation]] (DOPES) | ||
==External Links== | |||
*[https://maricopaemergencymedicine.com/battle-of-the-blades/ COPA STRONG: Battle of the Blades: The Death of DL?] | |||
*[https://www.merckmanuals.com/professional/critical-care-medicine/how-to-do-other-airway-procedures/how-to-do-orotracheal-intubation-using-video-laryngoscopy?query=video%20laryngoscopy Merk Manual - How To Do Orotracheal Intubation Using Video Laryngoscopy] | |||
===Videos=== | |||
{{#widget:YouTube|id=XY5g08gT-5Y}} | |||
==References== | ==References== | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Critical Care]] | |||
Revision as of 13:41, 17 July 2021
Overview
The C-MAC video laryngoscope (pictured above) has a Macintosh or "standard geometry" blade similar to that of a Macintosh direct laryngoscope (pictured below)
- Two most common devices are the C-MAC and the Glidescope
- Both CMAC and Glidescope systems offer both hyperangulated and standard geometry blades
- Increasingly utilized in emergency airway management[1]
Indications
- Any patient requiring intubation
- Particularly useful in patients with known or anticipated difficult intubation
Contraindications
- No absolute contraindications
- Relative:
- Blood or emesis in airway
- Foreign body removal
Equipment Needed
- Video laryngoscope
- Rigid stylet if hyperangulated blade is used
- All other equipment necessary for endotracheal intubation
Procedure
- Hyperangulated video laryngoscope
- Patient ideally in neutral spine position (as opposed to "sniffing" position for direct laryngoscopy)
- After induction, use right hand to "scissor" mouth open
- Place hyperangulated blade midline and slowly advance with progressive identification of airway landmarks
- Advance blade into vallecula
- When cords fill entire screen (Cormack-Lehane Grade I), slightly retract laryngoscopy so that cords only occupy upper 1/3 of screen (CL Grade II, allows for passage of ETT with rigid stylet)[2]
- If intubation is attempted with the best view possible, operators often have difficulty advancing the tube around the tongue and hypopharyngeal soft tissues
- Standard geometry video laryngoscope
- Same technique utilized with direct laryngoscopy
- Can either visualize directly or utilize video screen for tube delivery
Complications
- Risk of equipment failure with hyperangulated laryngoscope (unable to obtain direct view if screen fails)
- Risk of camera contamination with blood or emesis in airway
- Foreign body removal with hyperangulated laryngoscope less successful than with Macintosh laryngoscope [3]
See Also
Airway Pages
- Pre-intubation
- Induction
- Intubation
- Surgical airways
- Post-intubation
External Links
- COPA STRONG: Battle of the Blades: The Death of DL?
- Merk Manual - How To Do Orotracheal Intubation Using Video Laryngoscopy
Videos
{{#widget:YouTube|id=XY5g08gT-5Y}}
References
- ↑ Brown CA 3rd, Bair AE, Pallin DJ, Walls RM; NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations [published correction appears in Ann Emerg Med. 2017 May;69(5):540]. Ann Emerg Med. 2015;65(4):363-370.e1. doi:10.1016/j.annemergmed.2014.10.036
- ↑ Gu Y, Robert J, Kovacs G, et al. A deliberately restricted laryngeal view with the GlideScope® video laryngoscope is associated with faster and easier tracheal intubation when compared with a full glottic view: a randomized clinical trial. Une vue laryngée délibérément restreinte à l'aide du vidéolaryngoscope GlideScope® est associée à une intubation trachéale plus rapide et plus aisée qu'une vue glottique totale: une étude clinique randomisée. Can J Anaesth. 2016;63(8):928-937. doi:10.1007/s12630-016-0654-6
- ↑ Je, S. M., Kim, M. J., Chung, S. P., & Chung, H. S. (2012). Comparison of GlideScope® versus Macintosh laryngoscope for the removal of a hypopharyngeal foreign body: A randomized cross-over cadaver study. Resuscitation, 83(10), 1277–1280.