Abstract

The use of VLs for routine orotracheal OR intubation has gained popularity due to excellent glottic visualization, minimal cervical manipulation, and a high first-pass intubation success rate. However, despite clear benefits, reports of soft palate and tonsillar pillar injuries with VL use have increased, particularly with hyperangulated VL blades such as the GlideScope. These injuries may be associated with seemingly smooth intubations and are often unrecognized until after successful intubation or surgery completion.

When available and appropriate, using a Macintosh-shaped VL blade over a hyperangulated VL blade may result in less airway trauma. If a hyperangulated VL blade is used, alternating standard practice is vital to optimizing patient safety with its use. For example, using a flexible stylet or fiberscope with GlideScope intubations results in decreased time to successful intubation with significantly fewer airway injuries than a rigid stylet. In addition to stylet modifications, reinforced ETTs such as the BlockBuster ETT are associated with decreased incidence of injury with VL use versus intubation with a standard ETT. Recognizing predictors of difficult ETT passage with VL may allow for an adjusted approach to improve success and decrease complications. For example, a short thyromental distance and limited jaw protrusion may contribute to difficult ETT passage with the GlideScope due to a disproportionate oropharynx and limited space for the tube and blade in the oral cavity. In these patients, a smaller VL blade and a gum elastic bougie may improve intubation success and lessen contact with the patient's oral mucosa. More large-scale, high-quality studies are needed to quantify the incidence of airway trauma in OR intubations with hyperangulated blades versus Macintosh-shaped VL blades

Brooke Harris

Author Details

Brooke Harris, BSN

Sigma Membership

Non-member

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Videolaryngoscope, Airway Injury, GlideScope

Advisor

Greenway, Mary Beth

Degree

DNP

Degree Grantor

Samford University

Degree Year

2023

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2023-02-14

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