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Randomized Controlled Trial
. 2023 Sep 21;24(1):599.
doi: 10.1186/s13063-023-07641-1.

Comparison of video laryngoscope, video stylet, and flexible videoscope for transoral endotracheal intubation in patients with difficult airways: a randomized, parallel-group study

Tao Zhang  1 , Kai-Yuan Zhao  1 , Ping Zhang  1 , Ren-Hu Li  2
Affiliations
Randomized Controlled Trial

Comparison of video laryngoscope, video stylet, and flexible videoscope for transoral endotracheal intubation in patients with difficult airways: a randomized, parallel-group study

Tao Zhang et al. Trials. .

Abstract

Background: The 2022 ASA guidelines recommend the video laryngoscope, video stylet, and flexible videoscope as airway management tools. This study aims to compare the efficacy of three airway devices in intubating patients with difficult airways.

Methods: A total of 177 patients were selected and randomized into the following three groups: the video laryngoscope group (Group VL, n = 59), video stylet group (Group VS, n = 59), and flexible videoscope group (Group FV, n = 59). The success rate of the first-pass intubation, time of tracheal intubation, level of glottic exposure, and occurrence of intubation-related adverse events were recorded and analyzed.

Results: All patients were successfully intubated with three devices. The first-pass intubation success rate was significantly higher in Groups VS and FV than in Group VL (96.61% vs. 93.22% vs. 83.05%, P < 0.01), but it was similar in the first-pass intubation success rate between Groups VS and FV(P > 0.05). The number of patients categorized as Wilson-Cormack-Lehane grade I-II was fewer in Group VL than in Groups VS and FV (77.97% vs. 98.30% vs. 100%, P = 0.0281). The time to tracheal intubation was significantly longer in Group FV(95.20 ± 4.01) than in Groups VL(44.56 ± 4.42) and VS(26.88 ± 4.51) (P < 0.01). No significant differences were found among the three groups in terms of adverse intubation reactions (P > 0.05).

Conclusions: In patients with difficult airways requiring intubation, use of the video stylet has the advantage of a relatively shorter intubation time, and the flexible videoscope and video stylet yield a higher first-pass intubation success rate and clearer glottic exposure than the use of the video laryngoscope.

Trial registration: Chinese Clinical Trial Registry. No: ChiCTR2200061560, June 29, 2022.

Keywords: Airway management; Difficult airway; Intubation; Intubation devices.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Comparison of three devices used for transoral endotracheal intubation. A Video laryngoscope. B Video stylet. C Flexible videoscope
Fig. 2
Fig. 2
CONSORT flow chart for patient recruitment and randomization
Fig. 3
Fig. 3
Comparison of first-pass intubation success rate
Fig. 4
Fig. 4
Comparison of time to intubation
See this image and copyright information in PMC

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