title: Comparison of the Glidescope®, flexible fibreoptic intubating bronchoscope, iPhone modified bronchoscope, and the Macintosh laryngoscope in normal and difficult airways: a manikin study.
abstract: BACKGROUND
  Smart phone technology is becoming increasingly integrated into medical care.Our study compared an iPhone modified flexible fibreoptic bronchoscope as an intubation aid and clinical teaching tool with an unmodified bronchoscope, Glidescope® and Macintosh laryngoscope in a simulated normal and difficult airway scenario.
  
  
  METHODS
  Sixty three anaesthesia providers, 21 consultant anaesthetists, 21 registrars and 21 anaesthetic nurses attempted to intubate a MegaCode Kelly™ manikin, comparing a normal and difficult airway scenario for each device. Primary endpoints were time to view the vocal cords (TVC), time to successful intubation (TSI) and number of failed intubations with each device. Secondary outcomes included participant rated device usability and preference for each scenario. Advantages and disadvantages of the iPhone modified bronchoscope were also discussed.
  
  
  RESULTS
  There was no significant difference in TVC with the iPhone modified bronchoscope compared with the Macintosh blade (P = 1.0) or unmodified bronchoscope (P = 0.155). TVC was significantly shorter with the Glidescope compared with the Macintosh blade (P < 0.001), iPhone (P < 0.001) and unmodified bronchoscope (P = 0.011). The iPhone bronchoscope TSI was significantly longer than all other devices (P < 0.001). There was no difference between anaesthetic consultant or registrar TVC (P = 1.0) or TSI (P = 0.252), with both being less than the nurses (P < 0.001). Consultant anaesthetists and nurses had a higher intubation failure rate with the iPhone modified bronchoscope compared with the registrars. Although more difficult to use, similar proportions of consultants (14/21), registrars (15/21) and nurses (15/21) indicated that they would be prepared to use the iPhone modified bronchoscope in their clinical practice. The Glidescope was rated easiest to use (P < 0.001) and was the preferred device by all participants for the difficult airway scenario.
  
  
  CONCLUSIONS
  The iPhone modified bronchoscope, in its current configuration, was found to be more difficult to use compared with the Glidescope® and unmodified bronchoscope; however it offered several advantages for teaching fibreoptic intubation technique when video-assisted bronchoscopy was unavailable.
authors.affiliation: Department of Anaesthesia and Pain Management, QE II Jubilee Hospital, Metro South HHN, Coopers Plain, QLD 4108, Australia. AdrianLangley@gmail.com.
authors.forename: Adrian
authors.initials: A
authors.lastname: Langley
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mar Fan
mesh_terms: D000328:Adult; D020680:Bronchoscopes / Q000592:standards; D001999:Bronchoscopy / Q000295:instrumentation* / Q000379:methods; D040421:Cell Phone / Q000295:instrumentation* / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D004867:Equipment Design / Q000592:standards; D005260:Female; D006801:Humans; D020704:Laryngoscopes / Q000592:standards; D007828:Laryngoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008348:Manikins; D008875:Middle Aged; D014827:Vocal Cords / Q000033:anatomy & histology