Are Video Laryngoscopes The Standard of Care?
Readers believe every facility should have them on hand for managing difficult airways.
Daniel Cook, Executive Editor
No one can argue that video laryngoscopes are user-friendly devices that provide direct views of the glottis for easier endotracheal tube placement. But will they become the standard of care in airway management? Our online poll below revealed many of you think they will — at least during challenging intubations.
Difficult becomes routine
Patients with anterior larynxes are challenging to intubate with direct laryngoscopy and are ideally suited for video laryngoscopes, says D. John Doyle, MD, PhD, professor of anesthesiology at the Cleveland Clinic in Ohio. In marginal cases — patients with airways that are slightly problematic, but not obviously so — video laryngoscopy, or direct laryngoscopy with a video scope on standby, are effective alternatives to awake fiber-optic intubation.
"If the patient has a thick or short neck, video laryngoscopy helps tremendously when intubating," says Connie Casey, RN, CNOR, LHRM, administrator of the Northpoint Surgery and Laser Center in West Palm Beach, Fla. "You can see clearly with the scope when you can barely open the mouth."
Reader Survey on Video Laryngoscopes
1. Do you currently use a video laryngoscope?
Yes 85.9% No 14.1%
2. Would you be willing to work or host more challenging airway cases if you had access to a video laryngoscope?
Yes 59.7% No 40.3%
3. Do you think video laryngoscopes will become the standard of care?
Yes 67.8% No 32.2%
Source: Outpatient Surgery Magazine Reader Survey, September 2013, n=94
Providers might try to intubate with a direct laryngoscope before realizing it's much more difficult than they imagined. Instead of making a second attempt with a different direct blade or other technique, they can simply grab a video laryngoscope in the room or ventilate for another 30 seconds until a technician retrieves the device from storage.
"While not needed in most cases, the video laryngoscope has bailed me out of difficulty a great many times," says Dr. Doyle. He believes you should always have one readily available when routine intubations turn out to be anything but, although that doesn't mean you should always use it. Dr. Doyle works at a teaching institution, and understands the importance of keeping direct laryngoscopy skills sharp for routine cases.
Todd Stevens, MD, agrees. "I think traditional rigid laryngoscopes will remain the standard for routine intubations," he says. "However, I do believe that video laryngoscopes have become the de facto backup standard in the event of an anticipated or unanticipated difficult intubation."
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