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GlideScope Use improves intubation success rates: an observational study using propensity score matching.

Ibinson JW, Ezaru CS, Cormican DS, Mangione MP - BMC Anesthesiol (2014)

Bottom Line: Propensity scoring was then used to select 626 subjects matched between the two groups based on their morphologic traits.Thus, a propensity score based on these factors was used to balance the groups into two 313 patient cohorts.In addition, the GlideScope was found to be 99% successful for intubation after initial failure of direct laryngoscopy, helping to reduce the incidence of failed intubation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, VA Pittsburgh Healthcare System and Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA.

ABSTRACT

Background: Rigid video laryngoscopes are popular alternatives to direct laryngoscopy for intubation, but further large scale prospective studies comparing these devices to direct laryngoscopy in routine anesthesiology practice are needed. We hypothesized that the first pass success rate with one particular video laryngoscope, the GlideScope, would be higher than the success rate with direct laryngoscopy.

Methods: 3831 total intubation attempts were tracked in an observational study comparing first-pass success rate using a Macintosh or Miller-style laryngoscope with the GlideScope. Propensity scoring was then used to select 626 subjects matched between the two groups based on their morphologic traits.

Results: Comparing the GlideScope and direct laryngoscopy groups suggested that intubation would be more difficult in the GlideScope group based on the Mallampati class, cervical range of motion, mouth opening, dentition, weight, and past intubation history. Thus, a propensity score based on these factors was used to balance the groups into two 313 patient cohorts. Direct laryngoscopy was successful in 80.8% on the first-pass intubation attempt, while the GlideScope was successful in 93.6% (p <0.001; risk difference of 0.128 with a 95% CI of 0.0771 - 0.181).

Conclusion: A greater first-attempt success rate was found when using the GlideScope versus direct laryngoscopy. In addition, the GlideScope was found to be 99% successful for intubation after initial failure of direct laryngoscopy, helping to reduce the incidence of failed intubation.

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Related in: MedlinePlus

Graph illustrating the percent of intubations using each of the intubation devices as a function of attempt. With each successive intubation attempt, the use of a video laryngoscope increased.
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Fig2: Graph illustrating the percent of intubations using each of the intubation devices as a function of attempt. With each successive intubation attempt, the use of a video laryngoscope increased.

Mentions: A propensity score analysis based on the above traits was then performed in an attempt to balance the groups. Cases with an emergent case type or history of a difficult airway were not used as too few were present in the DL group. The propensity score technique pairs a patient in the DL group with one in the GS group that had the same probability (based on their characteristics) of being in the GS group. A total of 626 subjects were matched, 313 each in the GS and DL groups, within the prescribed limits. An excellent distribution matching resulted (Figure 1) and the patient characteristics for the DL and GS arms are given in Table 2, showing equally matched groups. Of the 313 DL patients, 253 (80.8%) were successfully intubated on the first-pass. In the GS group however, 293 of the 313 (93.6%) had first-pass success (p <0.001; risk difference of 0.128 with a 95% CI of 0.0771 – 0.181). Practitioner level was not found to significantly affect the success rate for the 626 patients in the propensity score analysis as the majority of intubation attempts were done by certified registered nurse anesthetist in both groups (51.4% for the GS group and 53.4% for the DL group).Of the 2496 patients initially in the DL group, a GlideScope was used for “rescue” purposes in 86 (3.4%, with a 95% confidence interval lower limit of 2.8%) for one of the subsequent attempts. 85 of these rescue attempts were eventually successful with the GlideScope. The percentage of intubations attempted with the GlideScope increased with each successive attempt (Figure 2). There were 13 patients that required more than 3 attempts. A single patient was not successfully intubated on the fourth attempt (three failed attempts with direct laryngoscopy, then one failed attempt with a GlideScope). This patient had a severe coagulopathy and the decision was made to use a flexible bronchoscope in order to avoid further trauma and potential bleeding from the continued use of a rigid device. All 3384 patients in the study were successfully intubated. If one counts the above mentioned conversion to a flexible fiberoptic bronchoscope as a “laryngoscopic failure”, then we observed an overall failure rate of 0.029% (1/3384, with a 95% confidence interval upper limit of 0.17%).Figure 1


GlideScope Use improves intubation success rates: an observational study using propensity score matching.

Ibinson JW, Ezaru CS, Cormican DS, Mangione MP - BMC Anesthesiol (2014)

Graph illustrating the percent of intubations using each of the intubation devices as a function of attempt. With each successive intubation attempt, the use of a video laryngoscope increased.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233079&req=5

Fig2: Graph illustrating the percent of intubations using each of the intubation devices as a function of attempt. With each successive intubation attempt, the use of a video laryngoscope increased.
Mentions: A propensity score analysis based on the above traits was then performed in an attempt to balance the groups. Cases with an emergent case type or history of a difficult airway were not used as too few were present in the DL group. The propensity score technique pairs a patient in the DL group with one in the GS group that had the same probability (based on their characteristics) of being in the GS group. A total of 626 subjects were matched, 313 each in the GS and DL groups, within the prescribed limits. An excellent distribution matching resulted (Figure 1) and the patient characteristics for the DL and GS arms are given in Table 2, showing equally matched groups. Of the 313 DL patients, 253 (80.8%) were successfully intubated on the first-pass. In the GS group however, 293 of the 313 (93.6%) had first-pass success (p <0.001; risk difference of 0.128 with a 95% CI of 0.0771 – 0.181). Practitioner level was not found to significantly affect the success rate for the 626 patients in the propensity score analysis as the majority of intubation attempts were done by certified registered nurse anesthetist in both groups (51.4% for the GS group and 53.4% for the DL group).Of the 2496 patients initially in the DL group, a GlideScope was used for “rescue” purposes in 86 (3.4%, with a 95% confidence interval lower limit of 2.8%) for one of the subsequent attempts. 85 of these rescue attempts were eventually successful with the GlideScope. The percentage of intubations attempted with the GlideScope increased with each successive attempt (Figure 2). There were 13 patients that required more than 3 attempts. A single patient was not successfully intubated on the fourth attempt (three failed attempts with direct laryngoscopy, then one failed attempt with a GlideScope). This patient had a severe coagulopathy and the decision was made to use a flexible bronchoscope in order to avoid further trauma and potential bleeding from the continued use of a rigid device. All 3384 patients in the study were successfully intubated. If one counts the above mentioned conversion to a flexible fiberoptic bronchoscope as a “laryngoscopic failure”, then we observed an overall failure rate of 0.029% (1/3384, with a 95% confidence interval upper limit of 0.17%).Figure 1

Bottom Line: Propensity scoring was then used to select 626 subjects matched between the two groups based on their morphologic traits.Thus, a propensity score based on these factors was used to balance the groups into two 313 patient cohorts.In addition, the GlideScope was found to be 99% successful for intubation after initial failure of direct laryngoscopy, helping to reduce the incidence of failed intubation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, VA Pittsburgh Healthcare System and Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA.

ABSTRACT

Background: Rigid video laryngoscopes are popular alternatives to direct laryngoscopy for intubation, but further large scale prospective studies comparing these devices to direct laryngoscopy in routine anesthesiology practice are needed. We hypothesized that the first pass success rate with one particular video laryngoscope, the GlideScope, would be higher than the success rate with direct laryngoscopy.

Methods: 3831 total intubation attempts were tracked in an observational study comparing first-pass success rate using a Macintosh or Miller-style laryngoscope with the GlideScope. Propensity scoring was then used to select 626 subjects matched between the two groups based on their morphologic traits.

Results: Comparing the GlideScope and direct laryngoscopy groups suggested that intubation would be more difficult in the GlideScope group based on the Mallampati class, cervical range of motion, mouth opening, dentition, weight, and past intubation history. Thus, a propensity score based on these factors was used to balance the groups into two 313 patient cohorts. Direct laryngoscopy was successful in 80.8% on the first-pass intubation attempt, while the GlideScope was successful in 93.6% (p <0.001; risk difference of 0.128 with a 95% CI of 0.0771 - 0.181).

Conclusion: A greater first-attempt success rate was found when using the GlideScope versus direct laryngoscopy. In addition, the GlideScope was found to be 99% successful for intubation after initial failure of direct laryngoscopy, helping to reduce the incidence of failed intubation.

Show MeSH
Related in: MedlinePlus