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Research Snapshot Theater: Quality and Patient Safety/Procedures, Adult and Pediatric

(1377) Too Much Tongue: Video Review of Glossal Interference During Intubations

Sunday, February 23, 2025

12:15pm – 1:15pm Eastern Time

Location: Connections Central - RST 14

First Author(s)

Amelia Bryan, MD (she/her/hers)

George Washington University Hospital
Arlington, Virginia, United States

Co-Author(s)

Samuel R. Winsten, MD (he/him/his)

Resident Physician
George Washington University, United States
Jordan Feltes, MD (he/him/his)

Washington, District of Columbia, USA
CL

Catherine Levitt, MD

Resident Physician
George Washington University, United States
AC

A. Pierce Campbell, DO

Resident Physician
George Washington University, United States
Kirsten Walton, MD (she/her/hers)

Resident Physician
George Washington University, United States
Peter W. Sweetser, MD (he/him/his)

USA
CJ

Caitlyn Johnson, MD

Resident Physician
George Washington University, United States
BA

Bonaventure Ahaisibwe, MBChB

Resident Physician
George Washington University, United States
DY

David Yamane, MD,

Associate Professor
George Washington University, District of Columbia, United States
Ayal Z. Pierce, MD

University of Maryland School of Medicine
Washington, District of Columbia, United States

Introduction: The introduction of Video Laryngoscopy (VL) as a tool for intubation allowed the development of a new laryngoscopic blade geometry: the hyperangulated blade. Traditional teaching with hyperangulated blades is that the sweeping motion utilized with standard geometry blades is not required. The goal of this study was to review hyperangulated intubations to determine if practitioners encountered difficulties with intubation as a result of tongue position.

Methods: We recorded and reviewed 93 consecutive intubations using hyperangulated video laryngoscopes. Intubations were performed at one mid-sized academic hospital by Emergency Medicine resident physicians under direct supervision of attending physicians. Variables examined were time to view of vocal cords, time to intubation, Lehane-Cormack grade of view and difficulties with managing the location of the tongue during intubation.

Results: Two different difficulties with tongue position were identified: difficulty getting past tongue while introducing blade into mouth, and tongue encroachment on final laryngoscopic view accounting for 13% (12/93) and 14% (13/93) of intubations reviewed respectively. Intubations that demonstrated difficulty entering the mouth had a statistically significantly longer time to achieve vocal cord view 21.8 (±12.3) sec compared to 8.7 (± 9.4) sec (P < 0.005). There was also an associated increase in time to tube delivery 50.5 (±20.6) sec versus 32.2 (±23.1) sec (P=0.006). Tongue encroachment on laryngoscopic view did not affect the intubation time. However, both difficulties were associated with an increased percentage of Grade 2 intubation views: 34.9% in difficulty entering mouth and 38.4%% in tongue encroachment versus 19.4% of standard intubations.

Conclusions: During most intubation attempts, practitioners did not encounter significant difficulties with tongue positioning when intubating using a hyperangulated blade. Difficulty initially introducing the blade into the mouth results in a statistically significant increase in time to intubation. Trouble with tongue positioning can worsen the quality of the vocal cord view obtained. The standard geometry approach of sweeping the tongue may provide benefit in cases where the tongue causes obstruction.