4. Discussion
COMPLICATIONS
Since introduction of Macintosh and Miller laryngoscopes in 40s of 20th century the direct laryngoscope is the mostly used laryngoscope type enabling intubation of trachea.The INT introduced in 2008, which has Macintosh like blade, has changed the lighting method used—the commonly used white light is replaced by a system of 2 different light sources: ultraviolet light and light emitting diode type light. This type of lighting increases the image contrast and reduces glare on wet mucous membranes during DL. The laryngoscope handle is made from aluminum, thereby making it lightweight, and the ergonomic shape with finger embossing makes the laryngoscope comfortable and intuitive to use. The arched profile of the handle allows for improved maneuvering during the intubation procedure which is important for less experienced operators.Airway management in the limited access situation creates a unique set of problems for intubation providers. Performance of basic and advanced airway maneuvers may become burdensome or near impossible using conventional approaches. The example of limited access to patient when performing airway management is intubation of patient entrapped in the vehicle. An intubation of a patient confined to a car driver seat ought to be immediately performed as long as evacuation is impossible and protection of the airways is a must.There is no many papers on advanced airways in entrapped patients. Those available are performed on group of experienced doctors: anesthesiologistsIn the inexperienced group, the INT resulted in a lower correlation of intubation success with the number of attempts. Although tracheal intubation with the classic and INTs, the number of attempts correlated significantly with efficacy, this correlation level was much lower when inexperienced individuals used the INT.This means that intubrite allowed a reduction in the number of attempts to achieve successful intubation. An even stronger tendency in this aspect was noted for difficult conditions. The significance level (assessing the correlation between the number of attempts made and successful intubations) decreased dramatically with intubrite intubation - compared to the classic laryngoscope. This shows that in the inexperienced group in difficult conditions, the validity of using the intubrite is even higher than during normal conditions.An analogous relationship was also demonstrated concerning experienced participants. Also, in their case, the level of effectiveness became significantly less correlated with the number of attempts performed when they worked with the INT under difficult conditions.Although emergency intubation remains the gold standard for airways management, it is also associated with the risk of complications.The above circumstances increase the risk of complications if the intubating personnel is not experienced.Similar conclusions are presented by Szirer, who emphasizes that the risk of complications increases, particularly in difficult intubation performed in the out-hospital setting.Our study shows that less experienced rescuers achieve the same efficiency when working with intubrite as professional rescuers with conventional laryngoscopes. Moreover, it has been proven that under difficult conditions, intubrite is as effective as a conventional laryngoscope under normal conditions.There are no other studies evaluating the use of intubrite videolaryngoscope by inexperienced intubators. Therefore we can compare results to those of other researchers performing studies on other videolaryngoscopes.Introducing new devices for clinical practice allows for better intubation performance by novice medical personnel. In the simulation study of O`Carroll et al novice intubators performed intubation with 4 different devices: standard laryngoscope, videolaryngoscope, AirTraq optical laryngoscope, and fiberoptic laryngoscope.Rya et al compared McGrath videolaryngoscope and standard laryngoscope in the hands of inexperienced intubators.The question is if manikin studies reveal a tendency that could be seen in actual patients. In the study of Shih et al, researchers evaluated intubation performed by novice intubators in patients using videolaryngoscope.In the study by twenty volunteers, who had had only manikin training for tracheal intubation and attempted 5 intubations with either technique in patients scheduled for general anesthesia, Nouruzi-Sedeh et al evaluated the use of videolaryngoscope in 200 patients.Another question is skill retention. In the study of Ghotbaldinian et al researchers evaluated to what extent recently acquired basic skills of endotracheal intubation, based on DL or VL, are being maintained over time by inexperienced operators after 3 months of intubation training.There is one study comparing INT with MAC in manikin settings, but the intubation was performed under conditions simulating those in non-hospital conditions, - the manikin was placed at the floor level without limited access to patient.