PURPOSE: Investigate the usefulness of the Shikani optical stylet (SOS) for endotracheal intubation (ET) when used by novices and to identify areas for improvement in our teaching and use of SOS.
METHODS: During the study period, 45 novices were trained in SOS aided intubations by a senior anesthesiology attending- each novice performing an average of 6-7 intubations. The SOS in the Anesthesiology Department is always connected to a TV monitor and video recorder. After a short bedside introduction to the SOS and the intubation technique, the novice attempts intubation under constant feedback and real-time guidance from the attending. To aid in training, all novice intubations are recorded and later reviewed. This practice generated video footage of novice SOS intubation attempts on 301 elective surgery patients from June 2001- June 2010. Data were collected from theses recordings on a pre-determined data collection sheet by two independent investigators. Number of attempts made by the novice, number of successful intubations, time to visualize the vocal cords and total time to intubate was recorded. For any unsuccessful attempts, the reasons for failure were carefully determined and recorded. These data were analyzed and complied by a third investigator.
RESULTS: Novices could intubate > 95% patients (283/297) with 79.8% (226) first attempt success. Ninety-three percent patients were intubated within 2 attempts and eighty-four percent in less than two minutes. The median total intubation time for novices was 73 seconds (Mean 78.42, SD 34.41). Median time to visualize cords was 38 seconds (Mean 44, SD 26.67) and the median time to insert tube was 30 seconds (Mean 34.34, SD 20.13). The novices took less than 60 seconds to visualize the cords in 74% of the attempts and took less than 60 seconds to insert the tube (after visualization of the cords) in 88% of the attempts
CONCLUSIONS: The novices overall success rate, first attempt success rate and median intubation time is better than the performance of the machintosh in many well-designed prospective trials and compares favorably to other, more expensive, alternatives. The Shikani is a safe and effective tool to train novices in endotracheal intubation.
CLINICAL IMPLICATIONS: The authors think that this tool might be most effective in the hands of Intensivists as they are already trained in bronchoscopy and are familiar with visualization and navigation with this tool. This should be tested in a well-designed prospective study.
DISCLOSURE: The following authors have nothing to disclose: Yashvir Sangwan, Basel Altaqi, McKenzie Mayo, Joseph Koveleskie
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