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Effects of gum elastic bougie in intubation with difficult airway

마네킹을 이용한 어려운 기도에서 부지 기관 내 삽관의 효과

  • Shim, Gyu-Sik (Department of Emergency Medical Technology, Korea Nazarene University) ;
  • Bang, Sung-Hwan (Department of Special Warfare Medical Non-Commissioned Officer, Daejeon Health Institute of Technology University) ;
  • Ahn, Hee-Jeong (Department of Emergency Medical Technology, Korea Nazarene University)
  • 심규식 (나사렛대학교 응급구조학과) ;
  • 방성환 (대전보건대학교 특전의무부사관과) ;
  • 안희정 (나사렛대학교 응급구조학과)
  • Received : 2020.02.28
  • Accepted : 2020.08.14
  • Published : 2020.08.31

Abstract

Purpose: This study aimed to find out the effectiveness of gum elastic bougies for intubation in comparison to stylet according to airway type using a manikin. Methods: The study subjects were 52 paramedic students who intubated using a Macintosh laryngoscope and compared stylet and gum elastic bougie use in a 7.5 mmID endotracheal tube, on a manikin with either normal or difficult airway. Difficult airway was made Philadelphia neck collar. Collected data included intubation time, accuracy and ease of intubation, later analyzed by frequency analysis, descriptive analysis, independent t-test, chi square test, paired t-test, and McNemar test using SPSS Statistics 18.0. Results: There was a significant difference in intubation time according to intubation device and airway type (p=.000). There was no significant difference in accuracy of intubation according to intubation device or airway type (normal airway p=1.000, difficult airway p=.052). There was a significant difference in ease of intubation scale according to intubation device and airway type (p=.000, p=.000). Conclusion: Based on the speed and ease of intubation, gum elastic bougie is recommended for intubation in patients with difficult airways such as those with cervical injury.

Keywords

References

  1. Kim BC, Kang BS, Song HG, Lee JH, Song KJ, Jeong YK. Endotracheal intubation in the emergency department of a tertiary care center. J Korean Soc Emerg Med 1999;10:579-86.
  2. Kim JH, Cho JS, Lim YS, Lee SB, Hyun SY, Kim JJ et al. The current state of airway management and ventilation at the pre-hospital stage by emergency medical technicians. J Korean Soc Emerg Med 2011;22(2):129-41.
  3. Choi GJ, Kang H. Safety and clinical usefulness of supraglottic airway device. J Korean Med Assoc 2015;58(10):905-14. https://doi.org/10.5124/jkma.2015.58.10.905
  4. Seo AR, Kim DH. Factors associated with advanced airway management while performing cardiopulmonary resuscitation for out-of-hospital cardiac arrest patients by 119 EMT. Korean J Emerg Med Ser 2019;23(1):157-63. https://doi.org/10.14408/KJEMS.2019.23.1.157
  5. Benoit JL, Gerecht RB, Steuerwald MT, McMullan JT. Endotracheal intubation versus supraglottic airway placement in out-ofhospital cardiac arrest: a meta-analysis. Resuscitation 2015;93:20-6. https://doi.org/10.1016/j.resuscitation.2015.05.007
  6. Kim HJ, Chung SP, Park IC, Cho J, Lee HS, Park YS. Comparison of the GlideScope video laryngoscope and Macintosh laryngoscope in simulated tracheal intubation scenarios. Emerg Med J 2008;25(5):279-82. https://doi.org/10.1136/emj.2007.052803
  7. Hwang SM. A good laryngeal view does not guarantee perfectly successful tracheal intubation. Koream J Anesthesiology 2016;69(2):111-2. https://doi.org/10.4097/kjae.2016.69.2.111
  8. Ham YL, Kim JH, Lee JG. The necessity for education on endotracheal intubation through vedio laryngoscope ? A focused on paramedic students-. Korean J Emerg Med Ser 2019;23(1):7-17. https://doi.org/10.14408/KJEMS.2019.23.1.007
  9. Yoon HW, Lee JM, Jung JY. Validation study of integrated intubation tube with stylet(IITS) in tracheal intubation. Korean J Emerg Med Ser 2019;23(3):111-21. https://doi.org/10.14408/KJEMS.2019.23.3.111
  10. Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation. A randomized clinical trial. JAMA 2018;319(21):2179-89. https://doi.org/10.1001/jama.2018.6496
  11. Messa MJ, Kupas DF, Dunham DL. Comparison of bougie-associated intubation with traditional endotracheal intubation in a simulated difficult airway. Prehospital Emergency Care 2011;15(1):30-3. https://doi.org/10.3109/10903127.2010.519821
  12. Nolan JP, Wilson ME. An evaluation of the gum elastic bougie. Anaesthesia 1992;47:878-87. https://doi.org/10.1111/j.1365-2044.1992.tb03154.x
  13. Choi WJ, Cho KJ. A comparison of endotracheal intubation using the Macintosh laryngoscope, the gum elastic bougie and the Pentax airway scope in neck-stabilized manikin. Korean J Emerg Med Ser 2011;15(3):71-80. https://doi.org/10.14408/KJEMS.2011.15.3.071
  14. Gataure PS, Vaughan RS, Latto IP. Simulated difficult intubation, comparison of the gum elastic bougie and the stylet. Anaesthesia 1996;51:935-8. https://doi.org/10.1111/j.1365-2044.1996.tb14961.x
  15. Sut EY, Gunal S, Yazar MA, Dikmen B. Comparison of effectiveness of intubation by way of "Gum elastic bougie" and "Intubating laryngeal mask airway" in endotracheal intubation of patients with simulated cervical trauma. Rev Bras Anestesiol. 2017;67(3):238 -45. https://doi.org/10.1016/j.bjane.2016.03.001
  16. Kidd JF, Dyson A, Latto IP. Successful difficult intubation, use of the gum elastic bougie. Anaesthesia 1988;43:437-8. https://doi.org/10.1111/j.1365-2044.1988.tb06625.x
  17. Kim SW, Kim EC, Choi YH, Kim YM, Oh YM, Choi HJ et al. The parameters affecting the success rate for endotracheal intubation in emergency department: Multi-center trial using Korean emergency airway management registry. J Korean Soc Emerg Med 2008;19(1):45-50.
  18. Maruyama K, Tsukamoto S, Ohno S, Kobayashi K, Nakagawa H, Kitamura A et al. Effect of cardiopulmonary resuscitation on intubation using a Macintosh laryngoscope, the AirWay Scope, and the gum elastic bougie: A manikin study. Resuscitation 2010;81:1014-8. https://doi.org/10.1016/j.resuscitation.2010.03.041
  19. Noguchi T, Koga K, Shiga Y, Shigematsu A. The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet. Can J Anaesth 2003;50:Article number 712. https://doi.org/10.1007/BF03018715
  20. Takenaka I, Aoyama K, Iwagaki T, Ishimura H, Takenaka Y, Kadoya T. Approach combining the airway scope and the bougie for minimizing movement of the cervical spine during endotracheal intubation. Anesthesiology 2009;110(6):1335-40. https://doi.org/10.1097/ALN.0b013e31819fb44a