title: Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions.
abstract: BACKGROUND
  The Glidescope video laryngoscope has been shown to be a useful tool to improve laryngeal view. However, its role in the daily routine of airway management remains poorly characterized.
  
  
  METHODS
  This investigation evaluated the use of the Glidescope at two academic medical centers. Electronic records from 71,570 intubations were reviewed, and 2,004 cases were identified where the Glidescope was used for airway management. We analyzed the success rate of Glidescope intubation in various intubation scenarios. In addition, the incidence and character of complications associated with Glidescope use were recorded. Predictors of Glidescope intubation failure were determined using a logistic regression analysis.
  
  
  RESULTS
  Overall success for Glidescope intubation was 97% (1,944 of 2,004). As a primary technique, success was 98% (1,712 of 1,755), whereas success in patients with predictors of difficult direct laryngoscopy was 96% (1,377 of 1,428). Success for Glidescope intubation after failed direct laryngoscopy was 94% (224 of 239). Complications were noticed in 1% (21 of 2,004) of patients and mostly involved minor soft tissue injuries, but major complications, such as dental, pharyngeal, tracheal, or laryngeal injury, occurred in 0.3% (6 of 2,004) of patients. The strongest predictor of Glidescope failure was altered neck anatomy with presence of a surgical scar, radiation changes, or mass.
  
  
  CONCLUSIONS
  These data demonstrate a high success rate of Glidescope intubation in both primary airway management and rescue-failed direct laryngoscopy. However, Glidescope intubation is not always successful and certain predictors of failure can be identified. Providers should maintain their competency with alternate methods of intubation, especially for patients with neck pathology.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Aziz
authors.forename: David
authors.initials: D
authors.lastname: Healy
authors.forename: Sachin
authors.initials: S
authors.lastname: Kheterpal
authors.forename: Rongwei F
authors.initials: RF
authors.lastname: Fu
authors.forename: Dawn
authors.initials: D
authors.lastname: Dillman
authors.forename: Ansgar M
authors.initials: AM
authors.lastname: Brambrink
mesh_terms: D000402:Airway Obstruction / Q000628:therapy*; D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014741:Video Recording