Difficult Intubation
Conditions
Keywords
PROVU, Videolaryngoscopy, Laryngoscopy
Brief summary
The aim of this open-label, randomized, 3-parallel arm trial is to compare success of intubation rate at first try between three groups that will be intubated: 1. Conventional intubation with hyperangulated videolaryngoscope (control group), 2. Intubation ProVu TM video stylet combined with hyperangulated videolaryngoscope, 3. Intubation ProVu TM video stylet combined with standard Macintosh laryngoscope.
Detailed description
Critical anesthetic incidents in the operating room are often related to airway management. Difficult airway management is defined as the clinical situation in which an anesthesiologist with conventional training has difficulty with upper airway face mask ventilation, difficulty with tracheal intubation, or both. Airway management has undergone a major transformation since the development of hyper-angle videolaryngoscopy (VL). Recently, the ProVuTM video stylet (Flexicare Medical Ltd, Mountain Ash, UK), which combines visualization technology with a tube guidance system, has been proposed as a new device for endotracheal intubation in participants with difficult airway management. The investigators hypothesized that the ProVuTM video stylet combined with videolaryngoscopy or standard laryngoscopy may improve the success rate of intubation on the first attempt compared with using a videolaryngoscope alone in patientes with predicted difficult intubation. In fact, using ProVuTM the position of the video stylet tip can be adjusted continuously during the tracheal intubation maneuver.
Interventions
DEVICEConventional intubation with hyperangulated videolaryngoscope
After the induction of general anesthesia, the patient will undergo conventional intubation with hyperangulated videolaryngoscope
DEVICEIntubation with ProVu TM video stylet combined with hyperangulated videolaryngoscope
After the induction of general anesthesia, the patient will undergo intubation with ProVu TM video stylet combined with hyperangulated videolaryngoscope
DEVICEIntubation with ProVu TM video stylet combined with standard Macintosh laryngoscope
After the induction of general anesthesia, the patient will undergo intubation with ProVu TM video stylet combined with standard Macintosh laryngoscope
Sponsors
Flexicare Medical Ltd
Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo di Alessandria
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Intervention model description
open-label, randomized, 3-parallel arm, monocentric trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients undergoing elective surgery requiring oral tracheal intubation; * ≥18 years of age; * simplified Arné score ≥11; * Written informed consent will be obtained from every participant.
Exclusion criteria
* ≤18 years of age * interincisor distance at maximal mouth opening ≤2 cm; * planned awake fiberoptic intubation because patients are patients considered to be high-risk for difficult intubation or difficult mask ventilation (e.g. with neck tumours, complete cervical arthrodesis; neck circumference \>50 cm); * patients at risk of gastric aspiration * planned nasal intubation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Success rate on first intubation attemps | During the procedure | The first-attempt intubation success is defined as tracheal tube placement with a single maneuver after insertion of the tube in the mouth. Reinsertion of the tube in the mouth counts as an additional attempt. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time of laryngoscopy | During the procedure | Time from insertion of the laryngoscope beyond the dental rhyme to the insertion of the tube beyond the dental rhyme |
| Number of intubation attempts | During the procedure | Times of reinsertion of the tube beyond the dental rhyme |
| Complications | During the procedure | Evaluation of the type and rate of complications, including desaturation \< 90%, esophageal intubation, tooth breakage and bleeding from the oropharyngeal mucosa |
| Use of jaw trust or BURP | During the procedure | Need to perform adjuvant maneuvers (jaw trust or BURP), measured with yes/no |
| Time of intubation | During the procedure | Time from insertion of the laryngoscope beyond the dental rhyme to cuffed tube |
| Needs to change the path of the intubation strategy | During the procedure | Needs to change intubation strategy, measured with yes/no, includes use of fiberoptic intubation, change of videolaryngoscope or postpone intervention |
| Learning curve analysis of intubation rate success | Through study completion, an average of 1 year | Improvement of intubation rate success |
| Learning curve analysis of time of procedure | Through study completion, an average of 1 year | Improvement of time of procedure |
| Need of another anesthesiologist intervention | During the procedure | Required intervention of another anesthesiologist, measured with yes/no, after 3 failed intubation attempt or after request of the first anesthesiologist |
Countries
Italy
Outcome results
None listed