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A Randomized Comparison of the GlideScope Videolaryngoscope to the Standard Laryngoscopy for Intubation by Pediatric Residents in Simulated Easy and Difficult Infant Airway Scenarios

Fonte, Miguel MD*; Oulego-Erroz, Ignacio MD*; Nadkarni, Lindsay†; Sánchez-Santos, Luis MD‡; Iglesias-Vásquez, Antonio MD, PhD§; Rodríguez-Núñez, Antonio MD, PhD*

doi: 10.1097/PEC.0b013e318217b550
Original Articles

Background: Videolaryngoscopy has been developed mainly to assist difficult airway intubation. However, there is a lack of studies demonstrating the real efficacy of its use in children. In this study, we tested the hypothesis that GlideScope (Verathon Inc, Bothell, Wash) videolaryngoscope improves tracheal intubation when used by pediatric residents in an advanced patient simulation model.

Methods: Pediatric residents who passed a pediatric advanced life support course were eligible for the study. An advanced infant simulator was used, and 4 scenarios were proposed: normal airway (NA), tongue edema (TE), tongue edema and oropharyngeal edema, and cervical collar. No participant had prior experience with any videolaryngoscope. After a brief instruction in GlideScope technique, each participant performed the 4 scenarios using both the standard Miller and GlideScope laryngoscopes, in a random sequence.

Results: Sixteen residents were included. The number of failed intubations was higher with GlideScope in NA and TE scenarios (3 vs 0, in both cases). Mean (SD) time to successful intubation was significantly longer with GlideScope in the NA scenario (GlideScope, 38 [SD, 13] vs Miller, 26 [SD, 16] seconds; P = 0.043). The number of maneuvers was significantly higher with GlideScope in the tongue edema and oropharyngeal edema scenario (2.3 [SD, 1.5] vs 1.5 [SD, 1]; P = 0.04). Upper jaw injury index was significantly lower with GlideScope in NA (2.0 [SD, 1] vs 2.6 [SD, 0.8]; P = 0.008) and cervical collar (2.1 [SD, 1.0] vs 2.8 [SD, 0.5]; P = 0.011) scenarios. Participants considered GlideScope technique more difficult than standard Miller in NA (5 [SD, 2.0] vs 3 [SD, 1.3]; P = 0.04) and TE (5.9 [SD, 2.5] vs 3.9 [SD, 1.7]; P = 0.02) scenarios.

Conclusions: In simulated scenarios of infant NA and difficult airway, when used by pediatric residents, GlideScope did not improve intubation performance when compared with the standard laryngoscope. Nevertheless, GlideScope may be safer for upper jaw injury and could have advantages in the management of complicated airway. Further studies are needed to assess if specific training will improve GlideScope intubation performance and whether the "in simulator" results translate into clinical practice.

From the *Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; †University of Pennsylvania, Philadelphia, PA; ‡Arzúa's Primary Care Center, Galicia's Health Service, Spanish Society of Primary Care Pediatrics, Madrid; and §Public Health Foundation Emerxencias Sanitarias 061 de Galicia, Santiago de Compostela, Spain.

Reprints: Miguel Fonte, MD, Hospital Clínico Universitario de Santiago de Compostela, UCI Pediátrica, Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain (e-mail: miguelfonte@gmail.com).

No potential conflict of interest was declared by any of the authors.

© 2011 Lippincott Williams & Wilkins, Inc.