Videolaryngoscopy for awake tracheal intubation in patients with anticipated difficult airways: a prospective multicentre cohort study

Abstract

[Abstract] Background: Although flexible bronchoscopy is considered the gold standard for awake tracheal intubation in patients with anticipated difficult airways (DA), videolaryngoscopy (VL) has emerged as a reliable alternative. The primary objective of this multicenter study was to evaluate the overall success rate of awake tracheal intubation using VL in patients with suspected DA.

Methods: We conducted a prospective, observational cohort study including all awake tracheal intubations performed with VL over a 3-year period in three hospitals. Data collected included the type of VL used (Airtraq®, C-MAC D-Blade®, or McGrath®X3), procedural success, number of intubation attempts, operator-perceived difficulty, and procedure-related complications.

Results: A total of 312 awake tracheal intubations were performed during the study period, with an overall success rate of 94.9% (296/312). In 298 patients, VL was the first intubation technique used in the operating room, with a success rate of 95% (283/298). No differences were found between non-channeled (95%) and channeled VLs (94.9%; p = 0.984). First-attempt success was achieved in 68.1% of patients (69.9% with non-channeled vs 61% with channeled VL; p = 0.235). The procedure was rated as easy or slightly difficult in 82.6% of cases (82% vs 84.8%; p = 0.425). The most frequent complication was impaired glottic visualization due to secretions (8.1%).

Conclusions: Videolaryngoscopy is an effective and safe alternative for awake tracheal intubation in patients with suspected difficult airways, achieving high success rates with few complications. No significant differences were observed between channeled and non-channeled devices.