Using a camera to intubate people and rodents - why video laryngoscopy is a superior.

Posted by: admin | June 17, 2013 | 0 Comments

Traditional laryngoscopy using a laryngoscope is difficult for even seasoned practitioners, and securing an airway is something that needs to be done quickly, safely and effectively. Endotracheal intubation's difficulty is compounded by factors such as cervical trauma, patient obesity and individual patient variability. There are reports that as many as 25 % of endotracheal intubations are actually esophageal intubations. Clearly, without the availability of end tidal CO2 monitoring to confirm endotracheal placement, there is significant possibility of iatrogenic death secondary to esophageal intubation. Traditional laryngoscopes are nothing more than a long metal blade with a light source. This light source can be of varying intensity, and is sometimes not adequate to enhance visualization. In addition, the metal blade is used to simply compress tissues out of the way, and is typically not an effective tool to directly visualize the larynx.

A relatively new tool is available to aid in endotracheal intubation. A video laryngoscope utilizes a video camera mounted to the end of the blade, and the viewing apparatus is either at the handle of the blade or as a separate unit. This camera allows direct visualization of the larynx and vocal chords and aids in correct placement as well as decreasing the time needed to perform intubation. With the ability to directly visualize the larynx (with some units having high-def resolution, color screens), intubation can be performed with less force, as tissues do not need to be compressed out of the way, and the head and neck do not need to be positioned and repositioned in order to try and visualize the glottis. Similar technology is now available for rodents. In species as small as mice and rats, endotracheal intubation is even that much more challenging. Flexible and rigid endoscopes smaller than 1 mm in diameter easily allow for direct visualization and rapid intubation.

When seconds count and an airway is "on the line", there seems to be no justification for not investing in a video laryngoscope. It is a superior product that costs more. However, if the difference is securing an airway that otherwise would be impossible to secure with a traditional laryngoscope, I think it would be hard to justify to family members that the patients life was not worth a few hundred dollars investment.

This is also true for rodent intubations, where multiple intubation attempts could introduce various cell types into the lungs (subsequently lead to misinterpretation of lavage samples), cause significant inflammation of the airway and even lead to laceration of the upper airway.

With the availability of this technology and the fact that its use could potentially save 25% of patients who were intubated esophageally, it seems like it would be foolish to opt for a "cost-saving" option, especially when that cost could be a life.