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In the previous study on mannekin, the investigators found stylet-assisted lifting of epiglottis is an useful technique on difficult airway (Cormack-Lehane grade IIIa, IIIb) without increasing subjective difficulty. It has no expenses other than the routine intubation process. Recently, the studies have proved that the bougie-assisted laryngoscopy can improve first pass intubation rate in the emergency department. However, bougie is a disposable device and may increased medical expenditure. The investigators will evaluate the safety of bougie and epiglottic lifting technique, as well as the first pass and overall success rate of intubation comparing to traditional video laryngoscopy and direct laryngoscopy.
A better strategy of managing Cormack-Lehane Grade III had been investigated by our previous study. The investigators' research results had been accepted and published by the journal BioMeidcal Central Anesthesiology. The investigators will be eager to do the further clinical trial to investigate the impact of this technique clinically. Besides, bougie assisted intubation is a effective, evidenced-proved intervention. The investigators will also like to find out the prognosis differences between these two techniques.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| bougie-assisted intubation | Active Comparator | use bougie as guide, intubation with loading endotracheal tube under direct or video laryngoscopy |
|
| intubation with epiglottic lifting | Active Comparator | Lifting of epiglottis with stylet-equipped endotracheal tube to assist intubation under direct or video laryngoscopy |
|
| Traditional intubation | No Intervention | intubation under direct or video laryngoscopy without epiglottis lifting nor bougie-assited |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| stylet-assisted epiglottic lifting | Procedure | use stylet-equipped enodtracheal tube to lift the epiglottis and pass the endotracheal tube |
|
| Measure | Description | Time Frame |
|---|---|---|
| first pass success rate | first pass sucess rate | through the intubation period, an average of 90 seconds |
| duration of intubation | through the intubation period, an average of 90 seconds |
| Measure | Description | Time Frame |
|---|---|---|
| Immediate complications direct related to intubation process | esophageal intubation, bleeding, tracheal perforation | through the intubation period, an average of 90 seconds |
| Overall success rate |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Taipei City Hospital Zhong-Xing branch | Recruiting | Taipei | 100 | Taiwan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28601269 | Background | Driver B, Dodd K, Klein LR, Buckley R, Robinson A, McGill JW, Reardon RF, Prekker ME. The Bougie and First-Pass Success in the Emergency Department. Ann Emerg Med. 2017 Oct;70(4):473-478.e1. doi: 10.1016/j.annemergmed.2017.04.033. | |
| 27843782 | Background | Ueda W, Arai YP. The Use of a Stylet to Aid the Lifting of the Epiglottis With a Video Laryngoscope. Anesth Pain Med. 2016 May 24;6(4):e38507. doi: 10.5812/aapm.38507. eCollection 2016 Aug. |
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Traditional intubation technique direct and video laryngoscope, bougie-assisted intubation, intubation with stylet assisted epiglottis lifting
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| bougie-assisted intubation | Device | use bougie as a introducer. Pass the bougie to the trachea and pass the tube via bougie guide. |
|
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Include all intubation event
| within 48 hours of intubation |