Association between glottis screen location and intubation difficulty: a retrospective video laryngoscopy study

Association between glottis screen location and intubation difficulty: a retrospective video laryngoscopy study

In emergency settings, difficult intubations often occur unexpectedly despite pre-intubation assessments. Traditional glottic view scoring systems for direct laryngoscope may not apply to video laryngoscopy. With video laryngoscopy, the vertical location of the glottis on the monitor can be clearly defined. If the glottis location is associated with intubation difficulty, it could serve as a simple indicator for anticipating intubation challenges. This study aimed to investigate the relationship between the glottis screen location during video laryngoscopy-guided intubation and the success and timing of the first-attempt intubation.

Among 209 laryngoscopy records, 113 had the arytenoid in the lower field of view and 96 in the upper field. Kaplan-Meier analysis showed a significantly lower cumulative success rate for intubations with a higher arytenoid location (log-rank test, P < 0.001). Multivariable Cox models, adjusted for factors like modified Cormack-Lehane grade, blade tip engagement, and other intubation findings, confirmed the arytenoid’s location as an independent predictor of successful intubation within 90 s, with an adjusted hazard ratio of 0.55 (95% confidence interval, 0.38–0.79) for the upper location group compared to the lower (P < 0.001).

Kai-Yuan Cheng, Pang Hsu Liu, Yung-Cheng Su, Yen-Yu Chen, Ya-Ni Yeh, Jih-Chun Lin & Ming-Jen Tsai

https://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-024-01148-x

BMC Emergency Medicine

18 december 2024

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