Lambert Christopher T, John Stephen C, John Anna V
From the Department of Anaesthesia & Critical Care, St Mary's Hospital, London, UK (CTL), Michigan Medicine (Medical Student), Ann Arbor (SCJ) and WMU Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA (AVJ).
Eur J Anaesthesiol. 2020 Nov;37(11):992-998. doi: 10.1097/EJA.0000000000001264.
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.
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.
A manikin study.
Forty-three experienced videolaryngoscope users in two London teaching hospitals.
Primary outcome: Intubation success rate.
grade of laryngeal view, median time to intubation and intubator-rated 'ease of use'.
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).
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.
虽然视频喉镜有助于处理困难气道，但对于资源有限的人来说，其价格仍然过高。我们在尼泊尔坦森联合使命医院开发了一种坚固耐用、可重复使用的低成本视频喉镜，它将能够拍摄静态和视频图像的智能手机兼容内窥镜与三维打印的、有通道的、超广角喉镜叶片相结合。在对其在困难气道人体模型上的性能进行评估之前，该视频喉镜叶片的计算机辅助设计文件通过电子邮件发送到伦敦并进行打印。
在“困难气道”人体模型（SimMan3G，舌头完全充气，颈部僵硬）中，将坦森视频喉镜（TVL）的插管性能与市售视频喉镜和传统麦金托什喉镜进行对比。
人体模型研究。
伦敦两家教学医院的43名经验丰富的视频喉镜使用者。
主要结果：插管成功率。
喉镜视野分级、插管中位时间和插管者评定的“易用性”。
在总体插管成功率（88%对98%对67%，P<0.05）、视野分级（中位科马克-莱汉内分级1级对1级对3级，P<0.01）、插管中位时间（17.5秒对15.5秒对27秒，P<0.01）方面，我们的设备与宾得AWS相当，且优于麦金托什喉镜（TVL对宾得AWS对麦金托什）。在主观“易用性”评分中，宾得AWS优于TVL，TVL优于麦金托什喉镜（李克特式1至5级评分：4分对4分对1分，P<0.00001）。
在这种困难气道的人体模型模拟中，“TVL”在插管成功率、喉镜视野分级和插管时间方面优于麦金托什喉镜，且不劣于宾得AWS视频喉镜。参与者发现宾得设备更易于使用，他们的反馈为我们改进设备提供了宝贵的见解。TVL价格低廉、简单且可重复使用，非常适合资源有限的环境。
