Letter to the Editor
Use of the video laryngoscopy in intensive care units
Uso de la videolaringoscopia en las unidades de cuidados intensivos
a Departmento de Anaesthesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
b Anesthesiology, Perioperative Medicine and Pain Management Research Group, Grupo Español de Vía Aérea Difícil (GEVAD), Spain
c Departmento de Anestesiología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
d Departmento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain
e Unidad de Cuidados intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, Spain
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"apellidos" => "Gómez-Ríos" "email" => array:1 [ 0 => "magoris@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Casans-Francés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Abad-Gurumeta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "A.M." "apellidos" => "Esquinas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Departmento de Anaesthesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anesthesiology, Perioperative Medicine and Pain Management Research Group, Grupo Español de Vía Aérea Difícil (GEVAD), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departmento de Anestesiología, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departmento de Anestesiología y Medicina Perioperatoria, Hospital Universitario Infanta Leonor, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Cuidados intensivos y Ventilación No Invasiva, Hospital General Universitario Morales Meseguer, Murcia, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de la videolaringoscopia en las unidades de cuidados intensivos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have carefully read the interesting study by Dey et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> comparing the use of the C-MAC video laryngoscope versus the Macintosh laryngoscope. We congratulate the authors for this. Several appreciations may be of interest.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In the methodological aspect, the absence of registration of the airway characteristics (for example, use of the MACOCHA scale) is a significant bias as the authors indicated since it does not guarantee the comparability of both groups. Moreover, the critically ill patient is characterized by a limited physiologic reserve, so the variable “time” as well as the success rate of each device, has a significant clinical impact.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> In other words, success is not enough. It must be obtained in the shortest time; otherwise, it may increase morbidity and mortality secondary to hypoxia.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> It is recommended in clinical practice to reduce the number of attempts to three as well as the instrumentalization time to avoid progression to a “cannot intubate cannot oxygenate” situation and to opt for alternative methods or devices in the event of a failed primary attempt.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The authors do not specify the local algorithm followed when failed intubation was declared, which is important. The study determined that the C-MAC required significantly more times a stylet to perform tracheal intubation. It is necessary to remember that there are several case reports of the upper airway injury secondary to its use as an adjuvant.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Currently, the routine use of video laryngoscopy<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> is defended in order to perform atraumatic tracheal intubations in the shortest time, although it is important to take care of two aspects; the experience and the type of device selected according to the context; otherwise, the results may differ from those expected.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> Thus, video laryngoscopes with Macintosh blade such as C-MAC (Karl Storz, Tuttlingen, Germany) or McGrath MAC (Aircraft Medical, Edinburgh, United Kingdom) allow both direct and indirect laryngoscopy, making them the most appropriate for routine use, while those with a hyperangulated blade with or without a guide channel are reserved to treat the difficult airway as first choice or as a rescue device.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> There are many reasons that justify the use of a video laryngoscope as a primary device<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a>; they allow direct and indirect laryngoscopy in the case of those who have a Macintosh blade as previously exposed, reduce the incidence of an unanticipated difficult airway, optimize training by allowing instructions from a more experienced operator, maximize coordination of the team, allow the recording of the procedure, reduce the possibility of cross-infection when using disposable material and allow a greater distance from the operator with the airway of the patient.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are limited number of clinical trials on video laryngoscopy in critically ill patients. Similar multicenter studies are necessary to obtain more evidence in this setting.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intubation in the Intensive Care Unit: C-MAC video laryngoscope versus Macintosh laryngoscope" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. 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Mariscal-Flores" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2019" "volumen" => "66" "paginaInicial" => "177" "paginaFinal" => "180" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Videolaryngoscopy increases ‘mouth-to-mouth’ distance compared with direct laryngoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Hall" 1 => "A. Steel" 2 => "R. Heij" 3 => "A. Eley" 4 => "P. Young" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.15047" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2020" "volumen" => "75" "paginaInicial" => "822" "paginaFinal" => "823" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32221979" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004600000001/v1_202201040731/S2173572721001867/v1_202201040731/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004600000001/v1_202201040731/S2173572721001867/v1_202201040731/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572721001867?idApp=WMIE" ]
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