Infrared flashing light through the cricothyroid membrane to guide flexible bronchoscopic tracheal intubation

Abstract

Flexible bronchoscopic tracheal intubation is a fundamental technique in the management of the difficult airway but requires specific skills which may be both difficult to achieve and maintain. Therefore, techniques to improve its success should be developed. We present two cases, one where the ear, nose and throat surgeon could not view the glottis due to laryngeal pathology, and one where pathology in the oropharynx obscured access to the trachea during attempts at flexible bronchoscopic and videolaryngoscopic tracheal intubation. In both cases, tracheal intubation was subsequently successful due to the use of the Infrared Red Intubation System. This is an infrared light source that is secured to the anterior neck. It emits a flashing infrared light that is captured by the flexible bronchoscope, thus guiding the way to the trachea. These are the first reports of this technology being used for flexible bronchoscopic tracheal intubation in patients with severe airway pathology where conventional approaches had failed. Both cases emphasise that this technique can be of benefit in avoiding a surgical airway.

Infrared flashing light through the cricothyroid membrane as guidance to awake intubation with a flexible bronchoscope: A randomised cross‐over study

“…We found six reports on the clinical use of IRRIS in the literature 5,7,22–25 . Four were case reports, 24,25 or smaller retrospective case series, demonstrating the applicability of the technique for awake video‐bronchoscope‐guided intubation in patients with difficult 5,24,25 or extremely difficult 7 airways, and two reports demonstrated its successful use for rigid video‐laryngoscopic intubation in lean 23 and obese 22 patients without airway pathology.…”

“…7 This is mainly because of the lack of normal anatomical landmarks and the distorting and/or obstructing nature of the pathology. 7 Thus only the vocal cords themselves, or the trachea are reliable landmarks to complete the intubation successfully.…”

“…In patients with pathology in the airway, the identification of the correct pathway from the mouth or nose to the trachea during advancement of the flexible scope may be extremely difficult or even impossible 7 . This is mainly because of the lack of normal anatomical landmarks and the distorting and/or obstructing nature of the pathology 7 . Thus only the vocal cords themselves, or the trachea are reliable landmarks to complete the intubation successfully.…”

Use of the flexible bronchoscope and Infrared Red Intubation System in a known difficult airway in the intensive care unit

“… 5 The main advantage of IRRIS is to provide an easily identifiable landmark to aim for, particularly where the view may be suboptimal. IRRIS has been shown beneficial in the elective VL‐guided intubation of lean, respectively, extreme obese patients, 18 , 19 elective ATI‐FB in known difficult airways 20 and in ATI‐FB of an obstetric patient with a known difficult airway. 4 …”

“…5 The main advantage of IRRIS is to provide an easily identifiable landmark to aim for, particularly where the view may be suboptimal. IRRIS has been shown beneficial in the elective VLguided intubation of lean, respectively, extreme obese patients, 18,19 elective ATI-FB in known difficult airways 20 and in ATI-FB of an obstetric patient with a known difficult airway. 4 The incidence of tube impingement is reduced, if specialized tubes are used (e.g., LMA ® Fastrach™ ETT, Teleflex), the opening of the bevel is oriented posteriorly and the gap between the tube and the FB is minimized.…”