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A comparison of conventional tube and EndoFlex tube for tracheal intubation in patients with a cervical spine immobilisation.

Gaszynska E, Stankiewicz-Rudnicki M, Wieczorek A, Gaszynski T - Scand J Trauma Resusc Emerg Med (2013)

Bottom Line: The EndoFlex is a new type of tracheal tube with an adjustable distal tip that can be bent without the use of a stylet.The intubation procedure was performed by 16 anesthetists with different experience (5-19 yrs).The assessment of usability: very easy 3.3% vs. 20%, easy 83.4% vs. 56.7%, difficult 10% vs. 20% and very difficult 3.3% vs. 3.3% for standard endotracheal tube with stylet and EndoFlex, respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland. tomasz.gaszynski@umed.lodz.pl.

ABSTRACT

Background: The EndoFlex is a new type of tracheal tube with an adjustable distal tip that can be bent without the use of a stylet. The aim of this study was to compare a standard endotracheal tube with the EndoFlex tracheal tube for intubation in patients with simulated cervical spine injury.

Methods: A group of 60 patients without any kind of the cervical spine injury, classified as the ASA physiological scale I or II and qualified for elective surgery procedures were intubated with the use of classical Macintosh laryngoscope, and either a standard endotracheal tube with the intubation stylet in it or EndoFlex tube without stylet. The subjects were randomized into two subgroups. All patients have had the cervical collar placed on their neck for the simulation of intubation procedure in case of the spinal injury.

Results: The intubation procedure was performed by 16 anesthetists with different experience (5-19 yrs). Time of intubation with the use of EndoFlex tube was similar to that with a the use of standard endotracheal tube and intubation stylet: Me (median) 19.5 s [IQR (interquatile range) 18-50] vs. Me 20 s [IQR 17-60] respectively (p = 0.9705). No significant additional maneuvers were necessary during intubation with the use of EndoFlex tube in comparison with standard endotracheal tube (70% vs. 56.6%) (p = 0.4220). Subjective assessment of the usability of both tubes revealed that more anesthesiologists found intubations with the use of EndoFlex more demanding than intubation with conventional tracheal tube and intubation stylet. The assessment of usability: very easy 3.3% vs. 20%, easy 83.4% vs. 56.7%, difficult 10% vs. 20% and very difficult 3.3% vs. 3.3% for standard endotracheal tube with stylet and EndoFlex, respectively.

Conclusion: In conclusion we asses, that the EndoFlex tube does not improve intubation success rate, in fact it requires more maneuvers facilitating intubation and was found to be more difficult to use.

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Time to intubation (TTI) with studied devices [median, IQR (box), range (lines)] (p = 0.9705).
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Figure 3: Time to intubation (TTI) with studied devices [median, IQR (box), range (lines)] (p = 0.9705).

Mentions: There were no differences between groups in demographic data (Table 1). When evaluating patients airway we found that 26/30 pts in both groups had Mallampati grade 1 and no factors influencing intubation conditions. Assessment of laryngeal visualization according to Cormack-Lehane scale revealed significant differences between the two groups (Table 2). In the STYLET group, more patients had poorer visualization–CL grades III and IV. In spite of that, time to intubation with EndoFlex tube was not significantly shorter than that with a standard endotracheal tube with an intubation stylet: median 19.5 s [IQR (interquartile range) 18-50] vs. median 20 s [IQR 17-60] in EndoFlex and STYLET groups, respectively (p = 0.9705) (Figure 3). Distribution of TTI is presented in Figure 4. Twenty seven of 30 patients (90%) in each group were intubated by the first attempt. In the STYLET group, the remaining patients were intubated in the second attempt, and in EndoFlex group third attempt was needed for the remaining 3 patients. Cumulative success ratio for first attempt is presented in Figure 5. More additional maneuvers were needed during intubation with EndoFlex compared to intubation with standard endotracheal tube: 70% (21/30) vs. 56.6% (17/30) with no significant difference (p = 0.4220).


A comparison of conventional tube and EndoFlex tube for tracheal intubation in patients with a cervical spine immobilisation.

Gaszynska E, Stankiewicz-Rudnicki M, Wieczorek A, Gaszynski T - Scand J Trauma Resusc Emerg Med (2013)

Time to intubation (TTI) with studied devices [median, IQR (box), range (lines)] (p = 0.9705).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222123&req=5

Figure 3: Time to intubation (TTI) with studied devices [median, IQR (box), range (lines)] (p = 0.9705).
Mentions: There were no differences between groups in demographic data (Table 1). When evaluating patients airway we found that 26/30 pts in both groups had Mallampati grade 1 and no factors influencing intubation conditions. Assessment of laryngeal visualization according to Cormack-Lehane scale revealed significant differences between the two groups (Table 2). In the STYLET group, more patients had poorer visualization–CL grades III and IV. In spite of that, time to intubation with EndoFlex tube was not significantly shorter than that with a standard endotracheal tube with an intubation stylet: median 19.5 s [IQR (interquartile range) 18-50] vs. median 20 s [IQR 17-60] in EndoFlex and STYLET groups, respectively (p = 0.9705) (Figure 3). Distribution of TTI is presented in Figure 4. Twenty seven of 30 patients (90%) in each group were intubated by the first attempt. In the STYLET group, the remaining patients were intubated in the second attempt, and in EndoFlex group third attempt was needed for the remaining 3 patients. Cumulative success ratio for first attempt is presented in Figure 5. More additional maneuvers were needed during intubation with EndoFlex compared to intubation with standard endotracheal tube: 70% (21/30) vs. 56.6% (17/30) with no significant difference (p = 0.4220).

Bottom Line: The EndoFlex is a new type of tracheal tube with an adjustable distal tip that can be bent without the use of a stylet.The intubation procedure was performed by 16 anesthetists with different experience (5-19 yrs).The assessment of usability: very easy 3.3% vs. 20%, easy 83.4% vs. 56.7%, difficult 10% vs. 20% and very difficult 3.3% vs. 3.3% for standard endotracheal tube with stylet and EndoFlex, respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland. tomasz.gaszynski@umed.lodz.pl.

ABSTRACT

Background: The EndoFlex is a new type of tracheal tube with an adjustable distal tip that can be bent without the use of a stylet. The aim of this study was to compare a standard endotracheal tube with the EndoFlex tracheal tube for intubation in patients with simulated cervical spine injury.

Methods: A group of 60 patients without any kind of the cervical spine injury, classified as the ASA physiological scale I or II and qualified for elective surgery procedures were intubated with the use of classical Macintosh laryngoscope, and either a standard endotracheal tube with the intubation stylet in it or EndoFlex tube without stylet. The subjects were randomized into two subgroups. All patients have had the cervical collar placed on their neck for the simulation of intubation procedure in case of the spinal injury.

Results: The intubation procedure was performed by 16 anesthetists with different experience (5-19 yrs). Time of intubation with the use of EndoFlex tube was similar to that with a the use of standard endotracheal tube and intubation stylet: Me (median) 19.5 s [IQR (interquatile range) 18-50] vs. Me 20 s [IQR 17-60] respectively (p = 0.9705). No significant additional maneuvers were necessary during intubation with the use of EndoFlex tube in comparison with standard endotracheal tube (70% vs. 56.6%) (p = 0.4220). Subjective assessment of the usability of both tubes revealed that more anesthesiologists found intubations with the use of EndoFlex more demanding than intubation with conventional tracheal tube and intubation stylet. The assessment of usability: very easy 3.3% vs. 20%, easy 83.4% vs. 56.7%, difficult 10% vs. 20% and very difficult 3.3% vs. 3.3% for standard endotracheal tube with stylet and EndoFlex, respectively.

Conclusion: In conclusion we asses, that the EndoFlex tube does not improve intubation success rate, in fact it requires more maneuvers facilitating intubation and was found to be more difficult to use.

Show MeSH
Related in: MedlinePlus