COVID-19 highlights value of video laryngoscopy
In emergency departments and intensive care units across the country COVID-19 has changed the way hospitals operate. With an increased need to support patients in respiratory distress, a new focus is being placed on video laryngoscopy (VL) for intubating patients being put on a ventilator.
VL has won growing acceptance because the enhanced visualization makes it more likely intubation will be successful on the first try, making the process safer for physicians and patients compared to traditional direct laryngoscopy (DL). Additionally, VL reduces the risk of spreading a highly contagious virus.
“The availability of a video laryngoscope at every intubation minimizes errors and unforeseen difficulties, enhances feedback, learning and teaching,” says Marco Zaccagnini, Registered Respiratory Therapists/Certified Clinical Anesthesia Assistant. “It shares the intubation with the medical team and provides a safer environment for both the operators and patients.”
Endotracheal intubation involves inserting a plastic endotracheal tube through the mouth or nose, through the larynx (which includes the vocal cords), and finally into the trachea (windpipe). The tube is guided into place with a device known as a laryngoscope, before being attached to a ventilator.
In a conventional DL intubation, the physician can see the tip of the laryngoscope as it enters the mouth, but must then rely on “feel” and experience to make sure it avoids the esophagus and is positioned correctly. Direct laryngoscopy can be difficult with some patients. Obtaining a view of the larynx is key to this technique and can be influenced by factors such as the structure and mobility of the neck and jaw, as well as the anatomy of the upper airway.
Intubation is a common procedure, even more so during the COVID-19 epidemic, but it’s not risk-free. On occasion, damage may be done to the teeth, mouth or trachea, and the laryngoscope may be inserted accidentally into the esophagus. Sometimes the first laryngoscopy attempt is unsuccessful, requiring subsequent attempts. The risks to the patient increase with the number of attempts. In COVID-19 cases, healthcare providers performing laryngoscopy can be at higher risk of contracting the virus.
DL is challenging to master, but with experience, anesthesiologists and respiratory therapists become proficient with this technique and often find success on the first-pass attempt. Studies have shown, however, that medical students and novice anesthesia residents have significantly lower initial success rates than experienced anesthesiologists.