Articulating stylet for intubation

[coffeebythelake]

Any of you guys use this before? Thoughts?

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[norski]

Not the worst idea ever, but no.

 

[ans2021]

I've used it. Works pretty slick. Can be reused if sterilized again (haven't actually seen that done). LIke a fiber, you can have the tube placed on the articulating device ready to pull down into the cords when through.

 

[pjl]

I tried it. It was a great idea, that worked slightly less great. Not bad, just not as good as I hoped.
I bet a future version will be awesome.

 

[Status Sciaticus]

The idea behind it is to get the tube in the first time and save the critical seconds for desat. However, youre inherently increasing time to intubation by adding another step. Secondly, the premise of articulating it is to get it in to the anterior cords, which can be done with the glidescope stylets.

I fail to see the benefit of this versus an asleep fiberoptic. Oh it is single use and its unit cost is $150, defeating any cost-saving indication.
It may be of some use in a pinch in pregnant patients that you have to convert to GA to weave around the edematous tissues, but even then, its not really a practical application versus a mcgrath and a smaller tube.

 

[Morzh]

Might be useful in settings like the ICU and ED in community hospitals where the intubations are being done by people who perform the procedure occasionally / semi-regularly, but not daily. But probably not worth the expense for use during routine planned intubations where there is usually an expert present and the incidence of an unexpected failure is less than 1%.

As others have mentioned it seems like its main utility comes from the ability to hyper-angulate toward an anterior glottis, which is what the Glidescope stylet already is designed to do. For novices I've noticed that getting a decent view with the Glidescope is usually easy, but then they struggle for 30 seconds trying to maneuver the styletted tube into the right hole. Perhaps this device can make first-pass success slightly higher for such novice intubators.

 

[vector2]

Might be useful in settings like the ICU and ED in community hospitals where the intubations are being done by people who perform the procedure occasionally / semi-regularly, but not daily. But probably not worth the expense for use during routine planned intubations where there is usually an expert present and the incidence of an unexpected failure is less than 1%.

As others have mentioned it seems like its main utility comes from the ability to hyper-angulate toward an anterior glottis, which is what the Glidescope stylet already is designed to do. For novices I've noticed that getting a decent view with the Glidescope is usually easy, but then they struggle for 30 seconds trying to maneuver the styletted tube into the right hole. Perhaps this device can make first-pass success slightly higher for such novice intubators.

The utility of that device is not just to reach an anterior glottis, but that it can angulate the tip posteriorly as well- since when using a hyperangulated blade and glidescope stylet the tube sometimes hangs on anterior trachea right past the cords. Experts are usually pretty good at backing out the stylet and rotating the tube, but I've seen plenty of ED and ICU folks who can't troubleshoot a bad angle when engaging the glottis with either a bougie or styletted ETT.

 

[drmwvr]

...., but I've seen plenty of ED and ICU folks who can't troubleshoot a bad angle when engaging the glottis with either a bougie or styletted ETT.

This...lots of gadgets come down the pike...a flexible endoscope is an articulating introducer... any more, new stuff just add's one more siren's song (and levels of complexity) to folks that need better basic airway skills....

 

[MirrorTodd]

This...lots of gadgets come down the pike...a flexible endoscope is an articulating introducer... any more, new stuff just add's one more siren's song (and levels of complexity) to folks that need better basic airway skills....

Agreed.

 

[IMGASMD]

Never used the device.

Checked out their YouTube demo. If I can see the cords as they showed in video, would not use any devices.

 

[GassYous]

Stylets are for *******

 

[nimbus]

It might have been useful pre-glidescope era. It’s time has come and gone.

 

[coffeebythelake]

It might have been useful pre-glidescope era. It’s time has come and gone.

definitely the number of cases where you would legit need this is low.
but people still use bougies today

 

[deleted162650]

people still use bougies today

Poor Man’s Glidescope. I’ll bust one out every now and again when the Glides are occupied.

 

[coffeebythelake]

Poor Man’s Glidescope. I’ll bust one out every now and again when the Glides are occupied.

It is occasionally helpful with glidescope intubation. Problem is that angulation can be very sharp so even w good glide view sometimes advancing tube will hit anterior trachea. Stylette very stiff and can cause injury. So we try turning just the ett past gnostic opening and if still having trouble i occadionally use a boogie to guide it through

 

[deleted59964]

hmm this looks like a solution ... to a problem that no longer exists

 

[secretasianman]

Don’t need it. Bet it can hit the g spot though.

 

[jwk]

Tried one at ASA last year. Really don't see a use for it.

 

[MirrorTodd]

What I would rather have is an articulating endotracheal tube. I can't remember if it was the king LT or the combitube but one have those had a ring at the proximal end that was connected to a string embedded in the tube, pull up on the ring and it flexed the tube forward. Such a simple design and would be great for those anterior people that the standard stylet bend can't get to on the first try.

 

[nimbus]

What I would rather have is an articulating endotracheal tube. I can't remember if it was the king LT or the combitube but one have those had a ring at the proximal end that was connected to a string embedded in the tube, pull up on the ring and it flexed the tube forward. Such a simple design and would be great for those anterior people that the standard stylet bend can't get to on the first try.

They used to make this endotracheal tube. Last time I saw it was in the early 1990’s. We used them for blind nasal intubations because it had a steerable tip.

 

[GassYous]

You could try loading the ett upside down on a glide stylet. So it's pointed up on the glide when the stylet is loaded but when you pull the stylet back the tube points downward into its natural curve.

 

[AdmiralChz]

I fail to see the benefit of this versus an asleep fiberoptic. Oh it is single use and its unit cost is $150, defeating any cost-saving indication.

Most (nice) fiber optic scopes are multiple thousands of dollars. Unless you get the trash AMBU ones which can’t suction worth crap.

I digress. A good Idea but I’d prefer one that can be sterilized and reused.

There are air ambulance services around me that do Glidescope+Bougie with EVERY intubation. Having cared for enough folks with Bougie injuries in our thoracic room, I think that’s asking for trouble.

 

[GassYous]

Most (nice) fiber optic scopes are multiple thousands of dollars. Unless you get the trash AMBU ones which can’t suction worth crap.

I digress. A good Idea but I’d prefer one that can be sterilized and reused.

There are air ambulance services around me that do Glidescope+Bougie with EVERY intubation. Having cared for enough folks with Bougie injuries in our thoracic room, I think that’s asking for trouble.

Can you expand on the bougie injuries? What are you seeing?

 

[MirrorTodd]

Most (nice) fiber optic scopes are multiple thousands of dollars. Unless you get the trash AMBU ones which can’t suction worth crap.

I digress. A good Idea but I’d prefer one that can be sterilized and reused.

There are air ambulance services around me that do Glidescope+Bougie with EVERY intubation. Having cared for enough folks with Bougie injuries in our thoracic room, I think that’s asking for trouble.

What sort of injuries? Perf'd tracheas or bronchi?

 

[coffeebythelake]

Most (nice) fiber optic scopes are multiple thousands of dollars. Unless you get the trash AMBU ones which can’t suction worth crap.

I digress. A good Idea but I’d prefer one that can be sterilized and reused.

There are air ambulance services around me that do Glidescope+Bougie with EVERY intubation. Having cared for enough folks with Bougie injuries in our thoracic room, I think that’s asking for trouble.

Bougies are quite malleable soft, they are meant to be advanced past the VC. what kind of injury?

 

[AdmiralChz]

In 2 years I’ve seen at least 4 or 5 anterior tracheal injuries from Bougies, or rigid stylets. 3 cases of resulting mediastinitis. Often I’ve seen folks have the Glidescope stylet in too far with a short tube so it’s coming out the end. The gum elastic bougies are fairly safe, but the other prehospital ones on the market are much stiffer and can cause injury. Point is, if VL or DL was done properly it’s not something that needs to be used 100% of the time.

 

[nimbus]

What I would rather have is an articulating endotracheal tube. I can't remember if it was the king LT or the combitube but one have those had a ring at the proximal end that was connected to a string embedded in the tube, pull up on the ring and it flexed the tube forward. Such a simple design and would be great for those anterior people that the standard stylet bend can't get to on the first try.

They used to make this endotracheal tube. Last time I saw it was in the early 1990’s. We used them for blind nasal intubations because it had a steerable tip.

Just found it. They still make it.

Covidien Endotrol Endotracheal Tube Cuffed 7.0 mm - 86351 — Serfinity Medical

Size: 7.0 mm Description Provides directional control of tip for emergency situations and abnormal intubation pathways Pilot balloon and mechanical self-sealing valve Large cuff diameter of 1-1/2 times the average trachea maintains proper low-pressure seal during tracheal expansion and...

serfinitymedical.com

 

[vector2]

Bougies are quite malleable soft, they are meant to be advanced past the VC. what kind of injury?

Rigidity varies dramatically between manufacturers.

 

[abolt18]

Just found it. They still make it.

Covidien Endotrol Endotracheal Tube Cuffed 7.0 mm - 86351 — Serfinity Medical

Size: 7.0 mm Description Provides directional control of tip for emergency situations and abnormal intubation pathways Pilot balloon and mechanical self-sealing valve Large cuff diameter of 1-1/2 times the average trachea maintains proper low-pressure seal during tracheal expansion and...

serfinitymedical.com

Randomly found one in our supplies and used it. Worked great!

 

[Status Sciaticus]

Most (nice) fiber optic scopes are multiple thousands of dollars. Unless you get the trash AMBU ones which can’t suction worth crap.

I digress. A good Idea but I’d prefer one that can be sterilized and reused.

There are air ambulance services around me that do Glidescope+Bougie with EVERY intubation. Having cared for enough folks with Bougie injuries in our thoracic room, I think that’s asking for trouble.

Sure, but the cost of sterilization is much less than $150. Additionally, you are contributing less to plastic waste accumulation. Yes, the cost of the scope should also play into account, but once you cross 50-100 intubations, youll come out ahead.

 

[drmwvr]

In 2 years I’ve seen at least 4 or 5 anterior tracheal injuries from Bougies, or rigid stylets. 3 cases of resulting mediastinitis. Often I’ve seen folks have the Glidescope stylet in too far with a short tube so it’s coming out the end. The gum elastic bougies are fairly safe, but the other prehospital ones on the market are much stiffer and can cause injury. Point is, if VL or DL was done properly it’s not something that needs to be used 100% of the time.

Sheesh...that's a lot. Makes me wonder if it's more the operators than the devices...DLT's are pretty obnoxiously shaped, stiff and styletted and I'm amazed at the relative lack of injury associated with those.

 

[coffeebythelake]

In 2 years I’ve seen at least 4 or 5 anterior tracheal injuries from Bougies, or rigid stylets. 3 cases of resulting mediastinitis. Often I’ve seen folks have the Glidescope stylet in too far with a short tube so it’s coming out the end. The gum elastic bougies are fairly safe, but the other prehospital ones on the market are much stiffer and can cause injury. Point is, if VL or DL was done properly it’s not something that needs to be used 100% of the time.

I can totally understand how a rigid glidescope stylet can jack up the airway

 

[GassYous]

Sheesh...that's a lot. Makes me wonder if it's more the operators than the devices...DLT's are pretty obnoxiously shaped, stiff and styletted and I'm amazed at the relative lack of injury associated with those.

We had a trachea torn into esophagus with one of these