A novel publication goes to enrich the long-living debate on direct laryngoscopy (DL) vs video laryngoscopy (VL) efficacy in emergency intubation.
The recent article pubblished on JEMS “Deploying the Video Laryngoscope into a Ground EMS System” compare the success rate beetwen DL vs VL in a ground EMS Service. The device used was the King Vision with channeled blade. The partecipants had a quik training consisting in didactic orientation and practical skills on manikins.
The result of the study shown that “Within the first 100 days of the study, the video laryngoscope utilizing the channeled blade has shown to be at least as effective as DL in relation to first-attempt success” and considering that “the mean experience in our group with DL is nine years, yet the success rate remains unacceptable” “It’s time to consider transition from a skill that’s difficult to obtain and maintain to one that appears to have a quicker learning curve and will likely result in decreased episodes of multiple attempts at intubation and associated complications.”
So is direct laryngoscopy dead?( Or will be so in a few years)
Here is what I think
There are some fundamental differences in VL tecnique respect the DL tecnique, that makes the DL more intuitive to pass the tube trough the cords.
We have basically 3 main axis in the airways
When we manage the airways we first put the head in “sniffing position” aligning the pharyngeal axis with the laryngeal one
Then we use the laryngoscope to align the mouth axis having so a direct view of the cords. This view coincide with the way to pass the tube, making this step intitive and easy.
Using the videolaryngoscope we take our eyes right in front of the larynx, having a perfect “video” view of the vocal cords, but also minimally modifying the axis of the mouth.
For this reason passing the OTT is not straight forward, so we need the stylet, the Bougie/Froban or the external glottic maneuvers, to facilitate the intubation.
This difference in tecnique makes the VL a little tricky in sense of the contrast between the perfect laryngeal view and the not intuitive passage of the tube trogh the cords.
The learning curve is
So I’ll ask you:
Wich way you prefer to go home?
The quickest and the shorter one for shure!
Do you use the GPS to go home?
Agree, me neither!
And when you use it?
Right! When you are lost!
So that’s why Direct Laryngoscope il still my Plan A
My straight way home!
Prehospital Airway Management Action Plan
Tags: Airway management, emergency medicine, medicina d'urgenza, medicina d'urgenza preospedaliera, prehospital emergency medicine, videolaryngoscopy
Le tue opinioni sono il nostro valore aggiunto!
MEDEST 
Gestione avanzata delle vie aeree: abbiamo bisogno di un piano B,C,D ed E!
15 DecLe linee guida per la gestione avanzata delle vie aeree in ambito preospedaliero ( Linee-guida per la gestione preospedaliera delle vie aeree SIAARTI/PAMIA 2009/2012) dopo la valutazione dell’indicazione, dell’opportunità e della fattibilità, consigliano di procedere all’intubazione orotracheale mediante laringoscopia diretta.
I 3 tentativi di intubazione della via aerea, come chiaramente spiegato nel testo, devono essere effettuati con presidi diversi e con mezzi aggiuntivi (Bougie, Mandrino, manovre esterne di manipolazione delle glottide), dopo di che, in caso di via aerea fallita, si passa al tentativo di ossigenazione e ventilazione mediante presidio extraglottico, ventilazione pallone maschera fino all’eventualità del paziente non intubabile/non ventilabile da gestire con la crico d’emergenza.
In linea con il lavoro di tutto il gruppo SIAARTI/PAMIA, e con la letteratura internazionale attuale, ecco una proposta operativa per i mezzi di soccorso territoriale sulla gestione razionale delle varie alternative a disposizione per la gestione delle vie aeree sul territorio.
Perchè intubare è una manovra, ma l’intubazione è una diagnosi!
Algoritmo per la gestione avanzata delle vie aeree
Share this:
Tags: Airway management, emergency medicine, emergenza sanitaria territoriale, gestione avanzata delle vie aeree, medicina d'urgenza, medicina d'urgenza preospedaliera, prehospital emergency medicine