BACKGROUND While videolaryngoscopes help in the management of difficult airways, they remain too expensive for those with limited resources. We have developed a robust, re-usable, low-cost videolaryngoscope at United Mission Hospital Tansen, Nepal, by combining a smartphone-compatible endoscope capable of capturing still and video images with a three dimensional-printed, channelled, hyperangulated blade. The computer-aided design file for the videolaryngoscope blade was emailed and printed in London before evaluation of its performance on a difficult airway manikin. OBJECTIVE To benchmark the intubation performance of the Tansen Videolaryngoscope (TVL) in a ‘difficult airway’ manikin (SimMan3G, tongue fully inflated, neck stiff), against a commercially available videolaryngoscope and a conventional Macintosh laryngoscope. DESIGN A manikin study. SETTING AND PARTICIPANTS Forty-three experienced videolaryngoscope users in two London teaching hospitals. INTERVENTION AND OUTCOME Primary outcome: Intubation success rate. Secondary outcomes: grade of laryngeal view, median time to intubation and intubator-rated ‘ease of use’. RESULTS Our device was equivalent to Pentax-AWS and superior to Macintosh laryngoscope (TVL vs. Pentax-AWS vs. Macintosh) in overall intubation success rate (88 vs. 98 vs. 67%, P < 0.05); grade of view (median Cormack-Lehane grade 1 vs. 1 vs. 3, P < 0.01); median time to intubation (17.5 vs. 15.5 vs. 27 s, P < 0.01). In subjective ‘ease of use’ scores, Pentax-AWS was superior to the TVL, which was superior to Macintosh laryngoscope (Likert-type 1 to 5 scale: 4 vs. 4 vs. 1, P < 0.00001). CONCLUSION In this manikin simulation of a difficult airway, the ‘TVL’ was superior to the Macintosh laryngoscope, and noninferior to the Pentax-AWS videolaryngoscope in intubation success rate, grade of laryngeal view and time to intubation. Participants found the Pentax device easier to use, and their feedback has given us valuable insights for improving our device. The TVL is well suited to settings in which resources are limited, being inexpensive, simple and re-usable.
BACKGROUND: Infant respiratory distress remains a significant problem worldwide, leading to more than one million neonatal deaths each year. The cost, maintenance, energy, and personnel required to implement ventilators have proven to be a barrier in many resource-limited settings. To address these barriers, a nonelectric bubble noninvasive positive pressure ventilation (NIV) device was developed. This study aims to benchmark the performance of this bubble NIV device against commercially available ventilators. METHODS: The delivered pressure waveforms and tidal volumes of the bubble NIV device were compared with those of 2 conventional ventilators (ie, Dr€ ager Evita Infinity V500 and Hamilton G5) at the following pressure settings: 8/5, 12/5, and 15/5 cm H 2 O. To simulate the lung mechanics of an infant in respiratory distress, tests were conducted on the IngMar ASL 5000 Test Lung simulator. Resistance was set at 100 cm H 2 O/L/s, and compliance was tested at 0.5, 1.0, and 2.0 mL/cm H 2 O to simulate 3 different patients. RESULTS: The delivered pressure waveforms and compliance curves of the bubble NIV device are similar to those of the Hamilton and Dr€ ager ventilators. The mean 6 SD differences between delivered versus set pressure gradient (ie, the difference between the high delivered pressure and the low delivered pressure) for each treatment modality across the various values of compliance were 22 6 8% for the bubble NIV device, 3 6 4% for the Dr€ ager ventilator, and 7 6 10% for the Hamilton ventilator. CONCLUSIONS: The similarity of pressure waveforms and delivered tidal volumes in this simulated clinical scenario suggest that the bubble NIV device may provide comparable efficacy compared with traditional ventilator treatment for a range of patients. This may provide clinicians in resource-limited settings with an additional, simple, nonelectric treatment modality for the management of infant respiratory distress.
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