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Diagnostics
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Advances in Tracheal Intubation
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Advances in Tracheal Intubation

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 October 2020) | Viewed by 14795

Special Issue Editor

Prof. Dr. Pavel Michalek

E-Mail Website
Guest Editor
1. Department of Anaesthesia and Intensive Medicine, Charles University and General University Hospital, U nemocnice 2, 12028, Prague, Czech Republic
2. Department of Anaesthesia, Antrim Area Teaching Hospital, Bush Road, BT412RL, Antrim, UK
Interests: airway management; difficult intubation; video laryngoscopy; supraglottic airway devices; fiberoptic intubation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite the rapid development of other techniques of airway management, such as insertion of a supraglottic airway device, tracheal intubation remains the “gold standard” for the maintenance of a patent airway during the majority of complex surgical procedures. Hundreds of millions of tracheal intubations are performed worldwide annually, not only in operating rooms but also in the intensive care setting, in accident and emergency departments, and also during life-threatening scenarios outside the hospital. Tracheal intubation is generally a safe technique but, if complicated or failed, it may affect patient outcome, including having fatal consequences. Proper assessment and preoperative diagnostics of potentially complicated conditions of tracheal intubation is a cornerstone of modern perioperative management. Several tools may help to diagnose a potentially difficult airway, including comprehensive physical examination, use of special scoring systems, application of an airway and neck ultrasound or the use of preoperative awake nasal endoscopy. According to these perioperative diagnostic tools, an appropriate plan for the technique of tracheal intubation and required equipment should be set up in advance.       

The aim of this Special Issue is to improve knowledge on recent advances in diagnostics of difficult tracheal intubation as well as the description of innovative or novel techniques concerning intubation of the trachea. Contributors may submit editorials, reviews, systematic reviews, meta-analyses, original articles, brief technical reports, and case reports.

Prof. Dr. Pavel Michalek
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Tracheal intubation
  • Diagnostics of difficult laryngoscopy
  • Fiberoptic endoscopy
  • Video laryngoscopy
  • Airway ultrasound

Published Papers (4 papers)

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Research

13 pages, 4823 KiB  
Article
A Comparison of a Standard Macintosh Blade Laryngoscope, Pentax-AWS Videolaryngoscope and Intubrite Videolaryngoscope for Tracheal Intubation in Manikins in Sitting and Prone Positions: A Randomized Cross-Over Study
by Tomasz M. Gaszyński
Diagnostics 2020, 10(8), 603; https://doi.org/10.3390/diagnostics10080603 - 18 Aug 2020
Cited by 8 | Viewed by 3120
Abstract
Background: Intubation of a patient in different positions may be done not only in emergency settings, but also in routine anesthesia (e.g., prone position for lumbar spine surgery). Methods: The aim of the study was to compare the classic Macintosh blade laryngoscope with [...] Read more.
Background: Intubation of a patient in different positions may be done not only in emergency settings, but also in routine anesthesia (e.g., prone position for lumbar spine surgery). Methods: The aim of the study was to compare the classic Macintosh blade laryngoscope with two videolaryngoscopes: the Pentax-AWS and the Intubrite in a simulated scenario of a manikin placed in a sitting and prone position. Additionally, intubation with the use of all three devices was performed in a standard supine position as the control group. The time of intubation and the pressure exerted on the tongue was assessed. The ANOVA Friedman (analysis of variance) and Wilcoxon with Bonferroni correction tests were used for statistical analysis. Results: The time of intubation in a prone position was significantly shorter for the Pentax-AWS videolaryngoscope compared to the Macintosh and the Intubrite. There were no significant differences in the obtained results of the evaluated devices in sitting and standard positions. The lowest pressure exerted on the tongue was with the Pentax-AWS, followed by the Intubrite and the Macintosh laryngoscopes. Conclusions: The use of the Pentax-AWS was associated with faster tracheal intubation, creating lower pressure on tongue when compared with standard Macintosh and Intubrite laryngoscopes in both prone and sitting positions. Full article
(This article belongs to the Special Issue Advances in Tracheal Intubation)
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6 pages, 5610 KiB  
Article
X-Ray and CT Scan Based Prediction of Best Fit Tracheostomy Tube—A Pilot Study
by Mel Corbett, Isobel Hughes, John O’Shea, Matthew G. Davey, Jane Savage, Joseph Hughes and Fintan Wallis
Diagnostics 2020, 10(8), 506; https://doi.org/10.3390/diagnostics10080506 - 22 Jul 2020
Cited by 5 | Viewed by 4170
Abstract
Tracheostomy is a commonly performed intervention in patients requiring ventilatory support. The insertion of inappropriately sized tracheostomy tubes carries a risk of decannulation, tissue damage, ventilatory difficulties, premature tube change or discomfort. Currently, no clear guidelines exist in determining the most appropriate size [...] Read more.
Tracheostomy is a commonly performed intervention in patients requiring ventilatory support. The insertion of inappropriately sized tracheostomy tubes carries a risk of decannulation, tissue damage, ventilatory difficulties, premature tube change or discomfort. Currently, no clear guidelines exist in determining the most appropriate size tube. Imaging of the airway preoperatively could aid clinical judgement and reduce risk. Patients included adult critical care patients who had appropriate preoperative imaging. The computed tomography scans and chest radiographs of patients were reviewed. Measurements of the airway were taken and scaled to the known internal diameter of an endotracheal tube. A four-point scoring system was developed to identify patients better suited to a non-standard sized tracheostomy tube. Data from 23 patients was analyzed using the Statistical Package for Social Sciences™ (SPSS). Four measured points on imaging corresponded to the patients’ appropriate tracheostomy tube size. Appropriate tracheostomy size correlates with tracheal diameter at endotracheal tube tip (r2 = 0.135), carina (r2 = 0.128), midpoint of larynx to carina (r2 = 0.146), bronchial diameter at the left mainstem (r2 = 0.323), and intrathoracic tracheal length (r2 = 0.23). Among our cohort, a score of 4 predicts the need for a larger tracheostomy tube. Simple imaging provides accurate measurement of patients’ airway dimensions. Our method ensures tube size is selected according to patient airway size, and potentially reduces the risks associated with inappropriate sizing. Full article
(This article belongs to the Special Issue Advances in Tracheal Intubation)
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9 pages, 1173 KiB  
Article
Clinical versus Ultrasound Measurements of Hyomental Distance Ratio for the Prediction of Difficult Airway in Patients with and without Morbid Obesity
by Cristina Petrișor, Sebastian Trancă, Robert Szabo, Robert Simon, Adrian Prie and Constantin Bodolea
Diagnostics 2020, 10(3), 140; https://doi.org/10.3390/diagnostics10030140 - 03 Mar 2020
Cited by 15 | Viewed by 3601
Abstract
Purpose: To describe the correlation between clinically measured hyomental distance ratio (HMDRclin) and the ultrasound measurement (HMDRecho) in patients with and without morbid obesity and to compare their diagnostic accuracy for difficult airway prediction. Methods: HMDRclin and HMDR [...] Read more.
Purpose: To describe the correlation between clinically measured hyomental distance ratio (HMDRclin) and the ultrasound measurement (HMDRecho) in patients with and without morbid obesity and to compare their diagnostic accuracy for difficult airway prediction. Methods: HMDRclin and HMDRecho were recorded the day before surgery in 160 consecutive consenting patients. Laryngoscopy was performed by a skilled anesthesiologist, with grades III and IV Cormack–Lehane being considered difficult views of the glottis. Linear regression was used to assess the correlation between HMDRclin and HDMRecho and receiver operating curve analysis was used to compare the performance of the two for predicting difficult airway. Results: The linear correlation between HMDRclin and HDMRecho in patients without morbid obesity had a Pearson coefficient of 0.494, while for patients with morbid obesity this was 0.14. A slightly higher area under the curve for HMDRecho was oberved: 0.64 (5%CI 0.56–0.71) versus 0.52 (95%CI, 0.44–0.60) (p = 0.34). Conclusion: The association between HMDRclin and HDMRecho is moderate in patients without morbid obesity, but negligible in morbidly obese patients. These might be explained by difficulties in palpating anatomical structures of the airway. Full article
(This article belongs to the Special Issue Advances in Tracheal Intubation)
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8 pages, 1316 KiB  
Article
Video Laryngoscopic Intubation Using the King VisionTM Laryngoscope in a Simulated Cervical Spine Trauma: A Comparison Between Non-Channeled and Channeled Disposable Blades
by Jiri Votruba, Tomas Brozek, Jan Blaha, Tomas Henlin, Tomas Vymazal, Will Donaldson and Pavel Michalek
Diagnostics 2020, 10(3), 139; https://doi.org/10.3390/diagnostics10030139 - 03 Mar 2020
Cited by 5 | Viewed by 3112
Abstract
Videolaryngoscopes may reduce cervical spine movement during tracheal intubation in patients with neck trauma. This manikin study aimed to compare the performance of disposable non-channeled and channeled blades of the King Vision™ videolaryngoscope in simulated cervical spine injury. Fifty-eight anesthesiologists in training intubated [...] Read more.
Videolaryngoscopes may reduce cervical spine movement during tracheal intubation in patients with neck trauma. This manikin study aimed to compare the performance of disposable non-channeled and channeled blades of the King Vision™ videolaryngoscope in simulated cervical spine injury. Fifty-eight anesthesiologists in training intubated the TruMan manikin with the neck immobilized using each blade in a randomized order. The primary outcome was the time needed for tracheal intubation, secondary aims included total success rate, the time required for visualization of the larynx, number of attempts, view of the vocal cords, and subjective assessment of both methods. Intubation time with the channeled blade was shorter, with a median time of 13 s (IQR 9–19) vs. 23 s (14.5–37.5), p < 0.001, while times to visualization of the larynx were similar in both groups (p = 0.54). Success rates were similar in both groups, but intubation with the non-channeled blade required more attempts (1.52 vs. 1.05; p < 0.001). The participants scored the intubation features of the channeled blade significantly higher, while visualization features were scored similarly in both groups. Both blades of the King Vision™ videolaryngoscope are reliable intubation devices in a simulated cervical spine injury in a manikin model when inserted by non-experienced operators. The channeled blade allowed faster intubation of the trachea. Full article
(This article belongs to the Special Issue Advances in Tracheal Intubation)
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