title: Difficult tracheal tube passage and subglottic airway injury during intubation with the GlideScope®videolaryngoscope: a randomised, controlled comparison of three tracheal tubes.
abstract: Difficulty during placement of the tracheal tube is a known problem when intubating with the GlideScope®, which may lead to subglottic airway injury. This randomised, controlled clinical trial was designed to compare the resistance to passage of PVC (polyvinyl chloride), reinforced or BlockBuster tracheal tubes during intubation with the GlideScope. Secondary outcomes included the time taken to intubate and assessment of subglottic airway injury. One-hundred and seventy-seven patients were included in the data analysis. There was difficult tracheal tube passage (moderate or severe resistance) in 15 (21.4%) patients using the PVC tube compared with 4 (7.4%) and 1 (1.9%) using the reinforced and BlockBuster tubes, respectively (p = 0.003 for PVC vs. BlockBuster). The median (IQR [range]) time taken to intubate was 35 (27-45 [15-115]) s, 25 (20-27 [15-110]) s and 25 (22-30 [16-90]) s, respectively, (p < 0.001 for PVC vs. reinforced as well as PVC vs. BlockBuster). Subglottic airway injury, assessed using a fibreoptic bronchoscope after extubation, was higher with the PVC tube (p < 0.001) and the reinforced tube (p = 0.012) compared with the BlockBuster tube. We conclude that the BlockBuster tracheal tube is a better choice for orotracheal intubation with the GlideScope than PVC or reinforced tubes.
authors.affiliation: Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: K
authors.initials: K
authors.lastname: Su
authors.affiliation: Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of Anaesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: F-S
authors.initials: FS
authors.lastname: Xue
authors.affiliation: Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: G-N
authors.initials: GN
authors.lastname: Ding
authors.affiliation: Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: M
authors.initials: M
authors.lastname: Tian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058109:Airway Management / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D005931:Glottis / Q000293:injuries*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation*; D020704:Laryngoscopes / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011143:Polyvinyl Chloride; D011183:Postoperative Complications / Q000453:epidemiology; D055815:Young Adult
chemical_list: D011143:Polyvinyl Chloride
keywords: airway management; complications; general anaesthesia; laryngoscopes; respiratory mucosa; tracheal intubation; videolaryngoscope