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Original Research

Open Access

Combined laryngo-bronchoscopy intubation approach in the normal airway scenario: a simulation study on anesthesiology residents

  • Luigi La Via1,*,
  • Simone Messina2
  • Federica Merola3
  • Francesco Tornitore2
  • Giulia Sanfilippo2
  • Cristina Santonocito1
  • Alberto Noto4
  • Federico Longhini2
  • Marinella Astuto1,†
  • Filippo Sanfilippo1,*,†,

1Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, site “Policlinico G. Rodolico”, 95123 Catania, Italy

2School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy

3School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy

4Department of Anesthesia and Intensive Care, University of Messina, 98100 Messina, Italy

DOI: 10.22514/sv.2023.053 Vol.19,Issue 4,July 2023 pp.91-98

Submitted: 21 July 2022 Accepted: 30 August 2022

Published: 08 July 2023

*Corresponding Author(s): Luigi La Via E-mail: luigi.lavia@unict.it
*Corresponding Author(s): Filippo Sanfilippo E-mail: filippo.sanfilippo@unict.it

† These authors contributed equally.

Abstract

Simulators aid airway training and also familiarization with new devices and techniques. Direct laryngoscopy (DL) is the most used method for endotracheal intubation (ETI), followed by video-laryngoscopy (VLS). The combined use of laryngoscopy with fiberoptic bronchoscope (combined laryngo-bronchoscope intubation, CLBI) has been proposed but its performances in novices and the best timing for introduction during training remain not explored. We performed a randomized, crossover study evaluating the CLBI approach in simulated normal airway scenario. Ninety-six anesthesia residents performed ETI with four approaches: DL, Glidescope®, McGrath® and CLBI. Residents were allowed maximum 3 attempts (up to 60 seconds each). Main outcomes were success rate (SR) and time-to-intubation corrected for SR (cTTI). Subgroup analysis was performed separating residents according to their experience (junior, n = 60; senior, n = 36). At first attempt, DL had higher SR (97%) than CLBI (50%, p < 0.001), Glidescope® (84%, p = 0.01) and McGrath® (67%, p < 0.001). After 3 attempts, ETI failure was higher for CLBI (19%) than with Glidescope® (2%, p < 0.001) or DL (1%, p < 0.001). CLBI showed longer cTTI (72(112) sec) than other devices (all p < 0.001: Glidescope® 25(23) sec, McGrath® 30(67) sec, DL 15(9) sec). The CLBI was the only approach performing better in senior as compared to junior residents (p = 0.03). In a normal airway simulation scenario, anesthesiology residents had lower SR and longer cTTI with CLBI technique as compared to DL and VLS. Our results suggest that CLBI could be introduced at senior stage of training, after DL and fiberoptic bronchoscope skills have been consolidated.


Keywords

Direct laryngoscopy; Endotracheal intubation; Fiberoptic bronchoscope; Manikin; Simulation; Video-laryngoscopy


Cite and Share

Luigi La Via,Simone Messina,Federica Merola,Francesco Tornitore,Giulia Sanfilippo,Cristina Santonocito,Alberto Noto,Federico Longhini,Marinella Astuto,Filippo Sanfilippo. Combined laryngo-bronchoscopy intubation approach in the normal airway scenario: a simulation study on anesthesiology residents. Signa Vitae. 2023. 19(4);91-98.

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