title: Comparison of the Truview PCD™ and the GlideScope(®) video laryngoscopes with direct laryngoscopy in pediatric patients: a randomized trial.
abstract: BACKGROUND
  The GlideScope(®) video laryngoscope has a 60° angled blade and the blade of the Truview PCD™ video laryngoscope has an optical lens that provides a 46° refraction of the viewing angle. Despite successful results using the GlideScope in adults, few studies have been published regarding its use in pediatric patients. We therefore tested our joint primary hypothesis that the GlideScope and the Truview PCD video laryngoscopes provide superior visualization to direct laryngoscopy and are non-inferior regarding time to intubation.
  
  
  METHODS
  One hundred thirty-four patients (neonate to ten years of age, American Society of Anesthesiologists physical status I-III) scheduled for general surgical procedures were randomized to tracheal intubation using the Truview PCD or GlideScope video laryngoscope or direct laryngoscopy (Macintosh blade). The laryngoscopic view was scored using the Cormack-Lehane scale. Time to intubation (defined as the time from the moment the device entered the patient's mouth until end-tidal CO2 was detected) and the number of attempts were recorded.
  
  
  RESULTS
  The Cormack-Lehane views attained using the GlideScope (P > 0.99) and Truview PCD (P = 0.18) were not superior to the views attained with direct laryngoscopy. Furthermore, the view attained using the GlideScope was significantly worse than that attained using direct laryngoscopy (P < 0.001). Fewer patients showed Cormack-Lehane grade I views with the GlideScope than with the Truview PCD (14% vs 82%, respectively; 95% confidence interval [CI] -91% to -46%). The observed median [Q1, Q3] times to intubation were: 39 [31, 59] sec, 44 [28, 62] sec, and 23 [21, 28] sec with the GlideScope, Truview PCD, and direct laryngoscopy, respectively, with median differences of 14 sec (95% CI 7 to 26, GlideScope - direct laryngoscopy) and 17 sec (95% CI 6 to 28, Truview PCD - direct laryngoscopy).
  
  
  CONCLUSIONS
  The Cormack-Lehane views attained using the GlideScope and the Truview PCD video laryngoscopes were not superior to views attained using direct laryngoscopy. Visualization with the GlideScope was significantly worse than with direct laryngoscopy. Use of the GlideScope and Truview PCD systems should be restricted to patients with specific indications.
authors: Department of Pediatric Anesthesia, Cleveland Clinic Children's Hospital, P21, 9500 Euclid Ave., Cleveland, OH 44195, USA. riveron@ccf.org
authors: Ricardo
authors: R
authors: Riveros
authors: Wai
authors: W
authors: Sung
authors: Daniel I
authors: DI
authors: Sessler
authors: Ivan Parra
authors: IP
authors: Sanchez
authors: Maria L
authors: ML
authors: Mendoza
authors: Edward J
authors: EJ
authors: Mascha
authors: Julie
authors: J
authors: Niezgoda
mesh_terms: D002245:Carbon Dioxide / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D013997:Time Factors; D020535:Video-Assisted Surgery / Q000379:methods
chemical_list: D002245:Carbon Dioxide