Endo Tracheal Intubation Pdf Download

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In most of these studies, success was defined not only by accurate anatomic placement of the endotracheal tube (ETT), but also by absence of significant complications [3-7]. Moreover, prehospital ETI was soon correlated with positive outcomes particularly in the most dire of circumstances [7,8,15].
Endotracheal intubation in the out-of-hospital setting. In the early years of out-of-hospital emergency medical services (EMS) systems, advanced life support personnel were not only trained in the nuances of how to avoid overzealous ventilation and properly place an endotracheal tube in very challenging circumstances, but they were also well-supervised on-scene by expert physicians who themselves were highly-experienced and exceptionally familiar with those challenges as well as methods to overcome them (photo by Dr. Paul Pepe).
Endotracheal intubation in the ICU is a challenging procedure and is frequently associated with life-threatening complications. The aim of this study was to investigate the effect of the C-MAC® video laryngoscope on laryngeal view and intubation success compared with direct laryngoscopy.
In a single-center, prospective, comparative before-after study in an anesthetist-lead surgical ICU of a tertiary university hospital, predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a 2-year study period (first year, Macintosh laryngoscopy (ML); second year, C-MAC®).
A total of 274 critically ill patients requiring endotracheal intubation were included; 113 intubations using ML and 117 intubations using the C-MAC® were assessed. In patients with at least one predictor for difficult intubation, the C-MAC® resulted in more successful intubations on first attempt compared with ML (34/43, 79% vs. 21/38, 55%; P = 0.03). The visualization of the glottis with ML using Cormack and Lehane (C&L) grading was more frequently rated as difficult (20%, C&L grade 3 and 4) compared with the C-MAC® (7%, C&L grade 3 and 4) (P < 0.0001).
Use of the C-MAC® video laryngoscope improved laryngeal imaging and improved the intubating success rate on the first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potentially difficult endotracheal intubations regularly occur.
Video laryngoscopes seem promising for airway management [7]. Video laryngoscopes contain a small camera and a light source at the distal third of the blade. The video picture is transferred to a monitor. The C-MAC® video laryngoscope (Karl Storz GmbH & Co. KG, Tuttlingen Germany) evaluated in this study uses Macintosh-shaped blades. Two approaches to visualize the glottis with the use of a Macintosh video laryngoscope blade are available: first, the direct view of the glottis; and second, an indirect view by means of a miniature camera on the screen of the monitoring unit. Several studies have shown the successful use of the C-MAC® in the operating room and in prehospital emergency medicine [8, 9]. The use of Macintosh blades with the C-MAC® improved the glottic view in patients who were difficult to intubate using direct laryngoscopy in the operating room [10]. These data cannot be directly translated to the situation on the ICU, because performing endotracheal intubation is more challenging in this environment.
The aim of this study was to evaluate the glottic view, number of intubation attempts and success rate of endotracheal intubation in an anesthetist-lead surgical ICU using Macintosh laryngoscopy (ML) or the C-MAC® video laryngoscope. Additionally, we evaluated whether the level of physician experience might influence visualization of the glottis or intubation success. We hypothesized that the use of a video la

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