• M Kriege, T Piepho, H Buggenhagen, and R R Noppens.
• Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
• Med Klin Intensivmed Notfmed. 2015 Apr 1; 110 (3): 218-24.

BackgroundVideo laryngoscopy has become increasingly important in airway management in the pre- and intrahospital settings. However, using video laryngoscopes in the presence of body fluids can make visualization of the airway difficult. A simulated regurgitation model was used to compare two video laryngoscopes (VL) with direct laryngoscopy.Materials And MethodsA total of 72 physicians participated in this randomized trial. The hypopharynx from an Airway Management Trainer was filled with artificially warmed turbid liquid. In addition, the cervical spine of the manikin was immobilized. The VL GlideScope® (GS) and McGrath® Series 5 (McG) were examined with the laryngoscope with Macintoshspatel (DL). Fogging of the camera optics in percent (0 %= clear view, 100 %= no view), the visibility of the glottis by Cormack and Lehane classification (C&L), and the POGO Score (percentage of glottic opening), the time until the endotracheal tube placement, and the success rate were evaluated.ResultsNo fogging (median 0 %) was present using the GS (interquartile range [IQR]: 0-4), in contrast 45 % fogging was found in the McG group (IQR: 30-60; p < 0.001). Glottic visualization using C&L was better using VL (p < 0.001). A similar result was observed using the POGO Scale: GS 90 % (IQR: 76-100), McG 80 % (IQR: 70-90), and DL 20 % (IQR: 0-50). The time for correct placement was in the DL with 27.6 s (IQR: 22.5-35) faster (p < 0.001), with the GS 48.5 s (IQR: 34.3-65.1) and the McG 66.3 s (IQR: 45.4-90). Successful placement was possible with GS in all cases (72/72), with DL in 71/72 cases, and with the McG in 70/72 cases.ConclusionUsing a video laryngsocope with an "anti-fogging" system improved visualization in a simulated aspiration model. In this scenario, VL showed no advantage to direct laryngoscopy in terms of success rate and speed of intubation.

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