Endotracheal intubation by inexperienced registrars in internal medicine: a comparison of video-laryngoscopy versus direct laryngoscopy

One of the most important tasks involved in the management of critically ill patients is to secure the airway. The preferred method for securing the airway is tracheal intubation followed by mechanical ventilation, but intubation is a difficult skill to acquire. When tracheal intubation using direct laryngoscopy is carried out by inexperienced personnel, there is a high risk of failure. Indirect laryngoscopy which uses a video-laryngoscope requires fewer skills to successfully secure the airway. We hypothesized that the use of the classical Macintosh laryngoscope is less effective in inexperienced hands compared with the video-laryngoscope GlideScope®, both in terms of successful intubation of the trachea and the time needed to achieve it. We asked thirty-nine registrars in internal medicine with negligible intubation experience to intubate a manikin airway model using a Macintosh laryngoscope and a video-laryngoscope GlideScope®. Inexperienced registrars with a mean duration of clinical experience as medical doctor of 1.7±1.0 years had a higher intubation success rate using the GlideScope® technique compared to the Macintosh technique (92% versus 69% respectively, P<0.05). However, the mean time needed for successful intubation was longer using the video-laryngoscope GlideScope® compared to the classical Macintosh laryngoscope (75±40 versus 39 ± 12 seconds respectively, P<0.05). In this study inexperienced registrars in internal medicine were able to intubate a manikin with a very high success rate using indirect video-laryngoscopy; however, the technique took more time to complete when compared with direct laryngoscopy.