Comparison of Digital Intubation (Two-finger) and Video Laryngoscopy

Isfahan University of Medical Sciences76 enrolled

Overview

Abstract Background: A number of patients referring to the emergency departments (EDs) due to airway obstruction or decreased level of consciousness require the establishment of a definite airway using intubation. On the other hand, performing Nasogastric tube (NGT) insertion is very challenging in anesthetized and intubated patients. And, a conclusive method has not yet been presented in this regard. Hence, the current study aimed at comparing Digital Intubation (two-finger) and Video Laryngoscopy methods during NGT insertion. Materials and Methods: The present clinical trial was performed on 76 intubated patients that were randomly divided into two groups. Groups A and B underwent Video Laryngoscopy and Digital Intubation (two-finger) methods, respectively. Then, the success rate, the number of attempts to insert NGT, duration of insertion, hemodynamic parameters, and patients' satisfaction level were recorded and examined in this study.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Enrollment

Conditions

Intubated Patients

Interventions

In the NGT Digital Intubation group (group B), the second and third fingers were placed in the posterior pharynx and depressed the tongue downwards. The NGT was passed through the nose into the posterior pharynx with the fingers in the pharynx to reach the esophagus. The thumb was placed under the jaw and pushed it forward to pave the way for tube insertion.

Video LaryngoscopyDEVICE

In the NGT Video Laryngoscopy group (group A), first, the GlideScope blade was inserted under direct visualization via color monitor through the patient's mouth by employing jaw-thrust maneuver to preserve the cervical spine and by raising the tongue to obtain better visualization of the larynx space. Then, NGT was inserted through the selected nostril, advanced through the esophagus under direct vision to meet the measured length, and fixed after confirmation.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18-65 year old patients that underwent rapid sequence intubation (RSI) and required NGT insertion Exclusion Criteria: * having skull base fracture symptoms * coagulopathy and hemorrhagic disorders * maxillofacial traumas leading to the deformity and disturbance in NGT insertion * diseases and anomalies of the upper respiratory tract * deviated nasal septum * nostril stenosis * esophageal disorders (esophageal stricture, esophageal varices) * a history of head and neck radiotherapy, and * patients intubated in and transferred from other centers * patients with more than two unsuccessful attempts at NGT insertion were excluded from the study.

Outcomes

Primary Outcomes

Success rate

being successfully inserted into the stomach

Time frame: Procedure (The start time was when NGT entered the selected nostril, and the end time was when the measured NGT length was fully entered the stomach.)

Secondary Outcomes

Insertion duration

Measuring how long will it last to insert successfully an NG tube into the stomach