DMV combined with DL is an infrequent but not rare phenomenon. Most patients can be managed with the use of direct or videolaryngoscopy. An easy to use unweighted risk scale has robust discriminating capacity.

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Background Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Methods Using a retrospective, observational, comparative design, the authors analyzed records from seven academic centers within the Multicenter Perioperative Outcomes Group between 2004 and 2013. The primary outcome was the comparative success rate for five commonly used techniques to achieve successful tracheal intubation after failed direct laryngoscopy: (1) video laryngoscopy, (2) flexible fiberoptic intubation, (3) supraglottic airway as part of an exchange technique, (4) optical stylet, and (5) lighted stylet. Results A total of 346,861 cases were identified that involved attempted tracheal intubation. A total of 1,009 anesthesia providers managed 1,427 cases of failed direct laryngoscopy followed by subsequent intubation attempts (n = 1,619) that employed one of the five studied intubation rescue techniques. The use of video laryngoscopy resulted in a significantly higher success rate (92%; 95% CI, 90 to 93) than other techniques: supraglottic airway conduit (78%; 95% CI, 68 to 86), flexible bronchoscopic intubation (78%; 95% CI, 71 to 83), lighted stylet (77%; 95% CI, 69 to 83), and optical stylet (67%; 95% CI, 35 to 88). Providers most frequently choose video laryngoscopy (predominantly GlideScope® [Verathon, USA]) to rescue failed direct laryngoscopy (1,122/1,619; 69%), and its use has increased during the study period. Conclusions Video laryngoscopy is associated with a high rescue intubation success rate and is more commonly used than other rescue techniques.

Increasing concern about the safety of transfusions and a desire to balance blood supply and blood needs stimulated a regional blood center to study the utilization of blood, rather than simply looking at distribution. A comprehensive survey of transfusion use, including packed red cells (RBCs), fresh-frozen plasma (FFP), and platelets (PLTs), was conducted in 12 Central Virginia hospitals. The medical records of 2579 transfused patients showed that the principal diagnoses in 23 percent of patients involved diseases of the circulatory system and those in 16 percent involved neoplasms, as classified under the diagnosis-related groups. Sixty-six percent (n = 1691) of patients had some type of surgery, with surgical patients overall using 1.9 times as many units of blood (RBCs, FFP, and PLTs) as nonsurgical patients. Mean patient age was 61 years, and the male:female ratio was 48:52 percent. This descriptive analysis of regional blood utilization has facilitated planning for local blood needs, provided indicators for areas of largest blood use, and given this region and others baseline data for future comparison.