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J Korean Soc Emerg Med > Volume 23(5); 2012 > Article
Journal of The Korean Society of Emergency Medicine 2012;23(5): 624-631.
Factors Related to Successful Endotracheal Intubations with Glidescope(R)
Ji Hoon Kang, Bo Seung Kang, Hyung Goo Kang, Young Suk Cho, Tae Ho Lim, Hyuk Joong Choi, Sae Hoon Park
1Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea. ardoc@hanyang.ac.kr
2Department of Emergency Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
The aim of this study was to analyze factors affecting success of endotracheal intubation (ETI) in emergency department (ED) patients, and to investigate usefulness of expected difficult direct laryngoscopy for expectation of a bad Glidescope(R) view.
ETI data using Glidescope(R) were collected at two EDs over a period of 64 months. We accessed intubator's training level, expected difficulty with laryngoscopy, method, and glottis exposure grade. Based on these variables, we analyzed the intubation success rates. And we examined the correlation between glottis exposure grade using Glidescope(R) and factors for expectation of difficult direct laryngoscopy.
A total of 613 ETIs attempts using Glidecope(R) were recorded. The overall success rate was 83.4%. In logistic regression analysis, expected difficult laryngoscopy, intubator's training level, and glottic exposure grade were independent predictive factors for successful ETI using Glidescope(R). The Cormack-Lehane grade I via Glidescope(R) was observed in 89.1% of total ETI attempts. In subgroup analysis, bad glottis exposure status showed a significantly low success rate irrespective of intubator's training level. Among the predicting factors for difficult laryngoscopy, morbid obesity, limited neck extension, and limited mouth opening showed an association with the degree of glottic exposure via Glidescope(R).
The glottic exposure grade was the most important factor related to successful ETI using Glidescope(R). Morbid obesity, limited neck extension, and limited mouth opening showed a significant association with bad glottis exposure under Glidescope(R), Therefore, we need to identify these findings. Even if in good glottis view, junior physicians showed a lower rate of ETI success using Glidescope, therefore, measurements to improve the ability of junior physicians should be implemented.
Key words: Tracheal intubation, Glidescope, Laryngoscope
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