GlideScope Intubation Overview Vector

GlideScope Intubation: An Overview (2024)

by | Updated: Mar 28, 2024

GlideScope intubation is a modern technique used in airway management to improve the success rate of endotracheal intubations.

The GlideScope is a video laryngoscopy device that provides a clear, magnified view of the glottis and vocal cords, making it easier for medical professionals to perform intubations even in challenging cases.

This technology is particularly valuable for use in pulmonary and critical care medicine, as it can significantly increase the first-attempt success rate in urgent situations compared to traditional direct laryngoscopy methods.

This article provides an overview of GlideScope intubation, exploring its advantages, technique nuances, and its place in modern clinical practice.

What is GlideScope Intubation?

GlideScope intubation is a procedure that utilizes a device to facilitate endotracheal intubation.

Endotracheal intubation is the insertion of a flexible plastic tube into the windpipe (trachea) to maintain an open airway and provide a means to administer oxygen, anesthesia, or other medications directly into the lungs.

The GlideScope is a type of video laryngoscope, which employs a small camera and a display screen to provide a clear view of the patient’s airway. This enhanced visibility improves the accuracy and safety of the intubation process, making it easier for healthcare professionals to position the endotracheal tube correctly.

GlideScope Vocal Cords Intubation

Compared to traditional direct laryngoscopy, which requires the practitioner to visually assess the airway using a laryngoscope, GlideScope intubation allows for better visualization of the glottis, the space between the vocal cords.

This is especially advantageous in cases where a patient has a difficult airway or when the practitioner is less experienced.

GlideScope Success Rate and Clinical Performance

The GlideScope video-laryngoscope has gained increasing recognition in anesthetic practice and emergency medicine settings due to its improved intubation success rates, particularly in cases of difficult intubation.

Multiple clinical publications and randomized controlled trials have validated the efficacy of Glidescope as a rescue device when direct laryngoscopy is unsuccessful.

A comparative study investigating the efficacy of the GlideScope versus the Macintosh direct laryngoscope showed that the GlideScope provided superior laryngeal visualization, facilitating tracheal intubation and managing difficult airways. This is especially relevant for clinicians with limited intubation experience.

Another systematic review and meta-analysis focused on the use of the GlideScope during cardiopulmonary resuscitation (CPR). The study found that the GlideScope improved tracheal intubation performance among clinicians with limited experience in such high-pressure situations.

Clinical trials have demonstrated impressive first-attempt success rates when using the Glidescope for intubation as compared to direct laryngoscopy. For example, Aziz et al. reported a 94% successful rescue rate in a retrospective study, highlighting the GlideScope’s potential as an invaluable tool in emergency settings.

Furthermore, the Glidescope has been associated with reduced lift force, which is particularly beneficial in minimizing the risk of trauma and complications during intubation procedures.

This also contributes to the device’s positive clinical performance, as the reduced force may result in a more comfortable and efficient procedure for both the patient and the clinician.

Summary: Multiple clinical publications and trials have demonstrated the Glidescope’s effectiveness in various clinical settings, with impressive first-pass success rates, particularly in difficult intubation cases. The device’s superior performance, combined with its ease of use and reduced lift force, have cemented its role as a valuable and reliable tool in clinical practice.

What is Airway Management?

Effective airway management is essential in providing optimal care to patients, especially those with difficult airways. It requires a thorough understanding of the critical anatomical, physiological, and pathological features related to the airway, as well as the various tools and methods used for this purpose.

Tracheal intubation is one of the key techniques in managing difficult airways. It involves the insertion of an endotracheal tube to facilitate ventilation and protect the patient’s airway from aspiration.

In difficult airway situations, various factors can complicate this procedure, including limited neck mobility, obesity, facial trauma, or certain medical conditions.

The GlideScope, a video laryngoscope, offers an effective alternative to direct laryngoscopy for managing complex airways. It provides a better view of the glottis, improving the likelihood of successful intubation. However, the intubation process with Glidescope may not always be straightforward, and experienced practitioners can still find success using direct laryngoscopy in some cases.

Multimodal Airway Management

Multimodal airway management involves adopting multiple techniques and tools to ensure a total airway solution for each patient.

The combination of video laryngoscopy, direct laryngoscopy, and fiberoptic bronchoscope guidance can improve the odds of successful intubation.

In particular, flexible fiberoptic intubation retains a significant role in managing difficult airways in specific patient populations.

Summary: Airway management is an essential aspect of patient care, especially in the context of difficult airways. Healthcare providers should be well-versed in the various tools and techniques, such as Glidescope intubation, fiberoptic intubation, and pediatric-specific approaches, to ensure effective airway management for every patient.

GlideScope Usage in Different Settings

GlideScope intubation is a valuable tool in various medical settings such as operating rooms (OR), emergency departments (ED), intensive care units (ICU), and critical care situations. It is particularly useful in performing urgent endotracheal intubations, where time is of the essence, and clear visualization of the airway is essential.

In the operating room (OR), GlideScope is frequently employed by anesthesiologists to facilitate swift and accurate endotracheal intubation.

Its video-assisted technology enhances visualization, leading to a greater success rate and reduced airway-related complications. Furthermore, the device is helpful in cases with limited mouth opening or restricted neck movement, which can make traditional laryngoscopy challenging.

In emergency departments (ED), GlideScope is a valuable tool for emergency medicine professionals. It allows them to rapidly secure the airway in critically ill patients, reducing the risk of hypoxia and other life-threatening complications. In addition, it may be particularly useful in managing patients with difficult airways due to anatomical variations, obesity, or facial trauma.

The use of a GlideScope in intensive care units (ICU) is increasingly common for urgent endotracheal intubation. In these settings, critically ill patients often require rapid and secure airway management.

GlideScope simplifies this process by providing clear, real-time visualization of the airway structures while minimizing the risk of dental or airway damage.

For critical care medicine fellows and emergency medicine professionals, the GlideScope offers an opportunity to improve competency in airway management skills, particularly when dealing with difficult intubations.

Its user-friendly design allows for quick and accurate placement of the endotracheal tube, which is essential in high-stakes, time-sensitive situations. Additionally, as a video laryngoscope, the GlideScope enables the entire team to observe and learn from the procedure, facilitating ongoing education and skill development.

Summary: GlideScope intubation is a versatile and valuable tool in various clinical settings, ranging from the operating room to the emergency department and intensive care units. Its ability to facilitate urgent endotracheal intubation and manage difficult airways makes it an indispensable resource for medical professionals across multiple disciplines.

What is Video Laryngoscopy?

Video laryngoscopy has emerged as a valuable tool in airway management, providing a clear view of the laryngeal structures and enabling clinicians to perform intubations more efficiently than with traditional direct laryngoscopy.

The video laryngoscope consists of a high-resolution camera mounted on a blade, offering improved visualization of the vocal cords and glottic opening.

These devices have been shown to improve the Cormack and Lehane view of the vocal cords compared to standard direct laryngoscopy.

Video-assisted blade laryngoscopy, such as the angulated GlideScope video laryngoscopes, has been particularly effective in enhancing airway management.

The use of video laryngoscopes has expanded in recent years to include intubation in critically ill patients, where securing the airway can be challenging and is associated with high morbidity and mortality.

Advantages

One advantage of video laryngoscopy is that it allows for dual-view airway procedures. The operator can view the laryngeal structures directly while at the same time observing the video screen.

This feature has been found to facilitate more accurate tube placement and reduce the risk of complications during intubation.

In addition, video laryngoscopy helps overcome some of the difficulties associated with direct laryngoscopy, such as poor patient positioning, limited mouth opening, or airway obstruction due to masses or surgical scarring.

Moreover, video laryngoscope devices have been increasingly applied in the past decade for various airway management situations.

For instance, the midline approach for endotracheal intubation using GlideScope video laryngoscopy is applicable in cases where the usual direct laryngoscopy approach may prove difficult.

Summary: Video laryngoscopy is a valuable technique for airway management that offers several advantages over direct laryngoscopy. It provides improved visualization of laryngeal structures, facilitates dual-view airway procedures, and can be useful in challenging intubation scenarios. The continued development and utilization of video laryngoscopes will likely lead to enhanced airway management practices and improved patient outcomes.

GlideScope Side Effects

GlideScope intubation has become a popular technique primarily because of its ability to visualize the larynx and vocal cords without relying on direct exposure.

This results in lower hemodynamic changes compared to a traditional Macintosh direct laryngoscope, leading to less trauma and stimulation of the oropharynx.

Postoperative sore throat is a common side effect of intubation, but the GlideScope technique seems to reduce this possibility due to the minimized trauma to the oropharynx.

It is important to note, however, that despite its advantages, GlideScope intubation has some subtle differences when compared to direct laryngoscopy. These differences may discourage some practitioners who are less familiar with the product from using it.

For pediatric patients, GlideScope intubation provides a safer alternative to direct laryngoscopy, as it allows for better visualization of the airway without causing undue stress on the delicate structures of their larynx. This can potentially reduce the risk of complications during the procedure.

Using a GlideScope to Streamline Workflow

Using the GlideScope for intubation can lead to a more efficient and streamlined workflow when conducted properly. One of the key factors in achieving a streamlined process is ensuring that all necessary equipment is readily available.

This includes having a suction device to clear secretions and maintain optimal laryngeal exposure during the procedure.

For GlideScope intubation, a midline approach helps achieve better Cormack-Lehane laryngoscopic views and first-pass success rates.

A crucial aspect to consider is the correct positioning of both the patient and the GlideScope itself. Proper positioning optimizes laryngeal exposure and can minimize the need for significant manipulation.

Additionally, it allows for easier insertion of the endotracheal tube and enhanced maneuverability.

Some useful tips include:

  • Inserting the blade to the left of the midline
  • Backing up the scope for a better view
  • Holding the tube close to the connector
  • Withdrawing the tube with your thumb for improved advancement through the vocal cords

An essential step in streamlining the workflow is good communication and collaboration among team members. This ensures a smooth sequence of events, from the initial patient assessment to the final tube placement and securement.

The roles of each team member, such as the anesthesiologist, respiratory therapist, and nursing staff, need to be clearly defined. A clear understanding of each member’s responsibilities contributes to a more efficient process with minimal complications.

Complementary Devices or Techniques

Consider using complementary devices or techniques that aid in GlideScope intubation. For example, the use of a stylet or a gum elastic bougie can facilitate the passage of the endotracheal tube in cases where glottic visualization is less than ideal.

These adjuncts can be helpful in promoting a smooth and successful intubation experience.

By following these strategies, healthcare professionals can create a more streamlined workflow and achieve higher success rates during GlideScope intubation.

The result is a quicker, safer, and more efficient procedure for both patients and practitioners.

FAQs About Intubation with a GlideScope

Is the GlideScope the Best Way to Intubate?

While the GlideScope offers many advantages, such as a clearer view of the larynx, it may not always be the “best” method for every situation or every clinician.

The choice of intubation method should be based on the individual patient’s anatomy, the clinician’s experience and comfort level, and the specific clinical circumstances.

What are the Advantages of GlideScopes?

GlideScopes offer several benefits, including:

  • Enhanced visualization of the larynx and vocal cords using video-assisted technology.
  • Increased success rates in difficult airways or challenging intubation scenarios.
  • Reduction in potential for tissue trauma due to indirect visualization, minimizing the need for excessive force or manipulation.
  • The ability to record or broadcast the procedure for educational or documentation purposes.

When Should You Use a GlideScope?

A GlideScope is particularly valuable in situations where a direct line of sight to the vocal cords is difficult or when traditional laryngoscopy has failed.

This includes patients with abnormal anatomy, the presence of blood or secretions, cervical spine immobilization, or any other anticipated difficult airway.

However, its utility isn’t limited to these situations; many clinicians opt for the GlideScope as their first choice due to its visualization advantages.

What is the Purpose of a GlideScope?

The primary purpose of a GlideScope is to aid in the visualization of the larynx and vocal cords during endotracheal intubation.

By providing an enhanced, magnified video-assisted view, it facilitates smoother and more efficient intubations, especially in challenging airway scenarios.

Is a GlideScope a Video Laryngoscope?

Yes, the GlideScope is a type of video laryngoscope. It uses a camera and a display screen to give an indirect view of the larynx, unlike traditional laryngoscopes, which rely on direct line-of-sight visualization.

What is the Difference Between a GlideScope and a Laryngoscope?

The primary difference between a GlideScope and a traditional laryngoscope is the method of visualization. While both are tools used for intubation, a traditional laryngoscope provides a direct view of the larynx using a blade and a light source.

In contrast, a GlideScope offers an indirect, video-assisted view using a camera attached to its blade and displays the image on a screen.

This video capability can offer improved visualization in many situations, especially when dealing with difficult airways.

Final Thoughts

GlideScope intubation stands as a pivotal advancement in airway management, offering clinicians a clearer, video-assisted view of the laryngeal anatomy.

This technology has not only increased the success rate of intubations, particularly in challenging cases, but also has contributed to enhanced patient safety.

As with any medical tool, proficiency requires practice and an understanding of its limitations.

As the landscape of medical technology continues to evolve, the GlideScope remains a testament to how innovation can drive significant improvements in clinical care.

John Landry, BS, RRT

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

References

  • Bacon ER, Phelan MP, Doyle DJ. Tips and Troubleshooting for Use of the GlideScope Video Laryngoscope for Emergency Endotracheal Intubation. Am J Emerg Med.
  • Dashti M, Amini S, Azarfarin R, Totonchi Z, Hatami M. Hemodynamic changes following endotracheal intubation with glidescope(®) video-laryngoscope in patients with untreated hypertension. Res Cardiovasc Med. 2014.
  • Avva U, Lata JM, Kiel J. Airway Management. [Updated 2023 May 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  • Ibinson JW, Ezaru CS, Cormican DS, Mangione MP. GlideScope Use improves intubation success rates: an observational study using propensity score matching. BMC Anesthesiol. 2014.
  • van Schuppen H, Wojciechowicz K, Hollmann MW, Preckel B. Tracheal Intubation during Advanced Life Support Using Direct Laryngoscopy versus Glidescope® Videolaryngoscopy by Clinicians with Limited Intubation Experience: A Systematic Review and Meta-Analysis. J Clin Med.
  • Zabani I, AlHarbi M, AlHassoun A, Iqbal S, Al Amoudi D, AlOtaibi S, Saad H. A comparative study of the efficacy of Glidescope versus Macintosh direct laryngoscopy for intubation in pediatric patients undergoing cardiac surgery. Saudi J Anaesth. 2021.
  • Peterson K, Ginglen JG, Desai NM, et al. Direct Laryngoscopy. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  • Jiang, Lianxiang, et al. “The Midline Approach for Endotracheal Intubation Using GlideScope Video Laryngoscopy Could Provide Better Glottis Exposure in Adults: A Randomized Controlled Trial.” BMC Anesthesiology, vol. 19, no. 1, Springer Science+Business Media, Nov. 2019.
  • Meitzen, S. E., and Jonathan L. Benumof. “Video Laryngoscopy.” Anesthesia & Analgesia, vol. 128, no. 3, Lippincott Williams and Wilkins, Mar. 2019.
  • —. “Is GlideScope® the Best Way to Intubate?” Anesthesiology, vol. 113, no. 1, Lippincott Williams and Wilkins, July 2010.
  • Aziz, Michael F., et al. “Routine Clinical Practice Effectiveness of the Glidescope in Difficult Airway Management.” Anesthesiology, vol. 114, no. 1, Lippincott Williams and Wilkins, Jan. 2011.

Recommended Reading