Comparaison du dispositif Vie Scope® et de la vidéolaryngoscopie pour la prise en charge de voies aériennes difficiles anticipées : une étude randomisée contrôlée

Abstract

Purpose The management of patients with an anticipated difficult airway remains challenging. We evaluated laryngeal visualization with the recently introduced Vie Scope® as a straight blade laryngoscope consisting of an illuminated tube necessitating bougie-facilitated intubation vs Macintosh videolaryngoscopy. Methods We conducted a prospective randomized controlled noninferiority trial. Patients undergoing elective ear, nose, and throat or oral and maxillofacial surgery with an anticipated difficult airway were randomized 1:1 to receive tracheal intubation with the Vie Scope or Macintosh videolaryngoscope (C-MAC®). The primary outcome measure was laryngeal visualization by the percentage of glottis opening (POGO) scale. Secondary outcome measures were the time to successful intubation (TTI) and first-attempt and overall success rates. Results We included two sets of 29 patients in our analysis. For visualization, the Vie Scope was noninferior to videolaryngoscopy (VL) with mean (standard deviation [SD]) POGO scores of 71 (31)% vs 64 (30)% in the VL group [difference in means, 7 (8)%; 95% confidence interval, –9 to 23; P = 0.38]. Mean (SD) TTI was 125 (129) sec in the Vie Scope and 51 (36) sec in the VL group (difference in means, 75 sec; 95% confidence interval, 25 to 124; P = 0.005). The first-attempt and overall success rates were 22/29 (76%) and 27/29 (93%) in both groups. Two patients per group were switched to a different device. Four accidental esophageal intubations occurred in the Vie Scope group, these were presumably due to bougie misplacement. Conclusion Visualization with the Vie Scope was noninferior to VL in patients with an anticipated difficult airway, but TTI was longer in the Vie Scope group. Study registration ClinicalTrials.gov (NCT05044416); registered 5 September 2021. Supplementary Information The online version of this article contains supplementary material available 10.1007/s12630-023-02534-y.

In reply: Parallel intubation technique with the Vie Scope® laryngoscope

“…Correct bougie placement may not be verified through the Vie Scope in situations with significantly restricted glottis view through the channel (i.e., grade 2C or worse); 4 , 5 in our previous study, we observed four unintended esophageal intubations in patients with expected difficult airways 2 probably due to bougie misplacement.…”

“…We thank Dr. Henlin et al . 1 for their interest in our work 2 and for sharing their interesting insights into the “parallel intubation technique.” We are pleased that the authors’ experience is consistent with our previously published study results 2 , 3 suggesting that glottis visualization with the Vie Scope ® (Adroit Surgical LLC, Oklahoma City, OK, USA) is superior to direct laryngoscopy and noninferior to Macintosh videolaryngoscopy, despite increased time-to-intubation. 2 , 3 In our opinion, the good visualization achieved with the Vie Scope is primarily due to direct epiglottis lifting, being a key element of straight-blade techniques and also significantly improving the glottis exposure in difficult Macintosh videolaryngoscopy.…”

“…Nevertheless, some potential disadvantages of the Vie Scope must be considered: The Vie Scope is designed to be used in a two-step bougie-assisted approach that prolongs time-to-intubation compared with a direct approach. 2 , 3 The tracheal tube is railroaded over the bougie without visualization of the laryngeal inlet; therefore, tube advancement cannot be visualized and tube impingement on the anterior commissure or arytenoids cannot be visually confirmed. 3 Correct bougie placement may not be verified through the Vie Scope in situations with significantly restricted glottis view through the channel (i.e., grade 2C or worse); 4 , 5 in our previous study, we observed four unintended esophageal intubations in patients with expected difficult airways 2 probably due to bougie misplacement.…”

“…The Vie Scope is designed to be used in a two-step bougie-assisted approach that prolongs time-to-intubation compared with a direct approach. 2 , 3 …”

In reply: Comparing devices for managing the difficult airway

“…We thank Bhakta et al 1 for their interest in our work 2 and for emphasizing the importance of the epiglottis–blade interaction in the management of difficult tracheal intubation.…”