Video laryngoscopy for tracheal intubation: an evidence-based analysis.
Bibliographic record
Abstract
OBJECTIVE: The objective of this health technology policy assessment was to determine the effectiveness and cost-effectiveness of video-assisted laryngoscopy for tracheal intubation. THE TECHNOLOGY: Video-assisted, rigid laryngoscopes have been recently introduced that allow for the illumination of the airway and the accurate placement of the endotracheal tube. Two such devices are available in Canada: the Bullard® Laryngoscope that relies on fibre optics for illumination and the GlideScope® that uses a video camera and a light source to illuminate the airway. Both are connected to an external monitor so health professionals other than the operator can visualize the insertion of the tube. These devices therefore may be very useful as teaching aids for tracheal intubation. REVIEW STRATEGY: The objective of this review was to examine the effectiveness of the most commonly used video-assisted rigid laryngoscopes used in Canada for tracheal intubation. According to the Medical Advisory Secretariat standard search strategy, a literature search for current health technology assessments and peer-reviewed literature from Medline (full citations, in-process and non-indexed citations) and Embase for was conducted for citations from January 1994 to January 2004. Key words used in the search were as follows: Video-assisted; video; emergency; airway management; tracheal intubation and laryngoscopy. SUMMARY OF FINDINGS: Two video-assisted systems are available for use in Canada. The Bullard® video laryngscope has a large body of literature associated with it and has been used for the last 10 years, although most of the studies are small and not well conducted. The literature on the GlideScope® is limited. In general, these devices provide better views of the airway but are much more expensive than conventional direct laryngoscopes. As with most medical procedures, video-assisted laryngoscopy requires training and skill maintenance for successful use. There seems to be a discrepancy between the seeming advantages of these devices in the management of difficult airway and their availability and uptake outside the operating room. The uptake of these devices by non-anesthetists in Ontario at this time may be limited because: Difficult intubation is relatively infrequent outside the operating roomMany alternative and inexpensive devices are availableThere are no professional supports in place for the training and maintenance of skills for the use of these devices outside anesthesia.Video laryngoscopy has no obvious utility in preventing airborne viral transmission from patient to provider but may be useful for teaching purposes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.049 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.007 |
| Bibliometrics | 0.011 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".