title: A randomized comparison of the GlideScope videolaryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios.
abstract: 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.
authors.affiliation: Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain. miguelfonte@gmail.com
authors.forename: Miguel
authors.initials: M
authors.lastname: Fonte
authors.forename: Ignacio
authors.initials: I
authors.lastname: Oulego-Erroz
authors.forename: Lindsay
authors.initials: L
authors.lastname: Nadkarni
authors.forename: Luis
authors.initials: L
authors.lastname: Sánchez-Santos
authors.forename: Antonio
authors.initials: A
authors.lastname: Iglesias-Vásquez
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Núñez
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000628:therapy; D002983:Clinical Competence; D004867:Equipment Design; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000193:education* / Q000379:methods; D008348:Manikins; D010372:Pediatrics / Q000193:education*; D014741:Video Recording