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Why continue to use conventional, indirect, line-of-sight approaches to intubate patients when video options exist? That's a good question. Video laryngoscopes make it safer and easier to manage a difficult airway, and are invaluable aids during touch-and-go, airway-related emergencies. Let's compare video laryngoscopy to conventional methods.
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The Features That Matter When Buying a Video Laryngoscope |
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Portability. A video scope is of no use if you can't get it to the patient when it's needed. Different devices address portability in different ways. Some are attached to a pole and rolled; others are self-contained in, for example, a jump bag. Consult with your providers to see which model they think would be easiest to move from room to room and bed to bed in your specific clinical setup. Ease of use. Look for scopes with intuitive designs so they can be used easily in a matter of seconds. The handle's grip, which typically resembles a conventional laryngoscope in feel and function, should fit comfortably in your providers' various-sized hands. If your providers want to record intubations for later review and educational purposes, you'll need video-capture and storage capabilities. Also consider that these devices can be used in all patient populations, from neonates to obese adults, which requires them to be flexible and adaptable to patients of all sizes with the appropriate array of sized adjuncts. Reliability. This is of paramount concern. Whether cord-powered or battery driven, the power source should pack enough juice to be unfailing. Image quality. Consider the clarity, brightness, screen size and ability to see at all angles, as well as the screen's degree of angle to the airway when the device is placed. High-def, color screens are certainly the preferred choice. Cost. Prices are dropping and competition in the growing market will eventually lower costs even further. Think of spending capital dollars on one of these patient safety devices as investing in an insurance policy. A single lawsuit stemming from mismanagement of an airway will cost far more than the purchase price. — William Landess, CRNA, MS, JD |
Comparison no contest
The difficulty of intubating is directly correlated with the practitioner's view of the glottis. Providers use Cormack and Lehane gradation scores to measure that view. Video laryngoscopy — which transmits clear images of the glottis — generally results in significantly higher scores compared to conventional methods. Those images are especially useful in difficult airways caused by anatomical abnormalities, obesity and cervical injuries, further endearing the burgeoning technology to anesthesia practitioners.
Providers also apply less force when using video laryngoscopes. The devices' natural curves match the airway's anatomy. That combines with video guidance to allow for safer, less traumatic intubations. Conventional laryngoscopy performed without visual aid, on the other hand, requires more manipulation of the airway to align the oral, pharyngeal and tracheal axes.
Practice makes perfect
Anesthesia providers often wonder about video laryngoscopy's learning curve. Like most anything else, it depends. Generally, providers who are proficient in conventional laryngoscopy transition easily to video laryngoscopes. Surprisingly, new anesthesia students seem to master video-guided intubation rather quickly, perhaps because they're more tech savvy than their elder predecessors. Providers with skilled hands, old or young, will catch on without much trouble. There is no finite number of video intubations that will make a provider proficient or even expert in the technology. It simply takes appropriate initial training and repetition.
Use of video laryngoscopy during routine intubations may not be necessary for experienced providers. The devices, however, are a tremendous teaching adjunct for students and novice practitioners. No matter the provider's level of experience, video guidance should be used occasionally on normal airways to prepare for the difficult, emergent case. When faced with failure to intubate and failure to ventilate, familiarization with video laryngoscopy may mean the difference between catastrophe and carrying on with the case as planned.
Matter of minutes
Difficult airways are becoming more prevalent in today's society, and it only takes one failed intubation to convince anesthesia practitioners to bolster their arsenal of airway adjuncts. Video laryngoscopes will give your facility an edge in protecting patients from harm and your facility from legal trouble.
But as sticker prices on new technology continue to rise, you'll be forced to prioritize which state-of-the-art devices you ultimately need to add. It'd be difficult to make a rational argument against the critical nature of airway adjuncts. You need to look beyond acquisition cost. I may be biased, but of all the equipment in the OR, no other piece is as crucial as airway management technology. What else is designed to save patients within minutes when every second counts? Remember, there is no case without an airway.
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