Direct laryngoscopy is the most common method of tracheal intubation in the Emergency Department. Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts. Make expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient’s tolerance for repeated or prolonged attempts at laryngoscopy. This results in hypoxemia and hemodynamic deterioration. Operator-related factors (e.g., experience, device selection, and pharmacologic choices) affect the odds of a successful intubation on the first attempt. Direct laryngoscopy will be difficult or impossible in approximately 1% to 3% of patients requiring intubation.1-4 This may be due to many different causes (e.g., excessive airway bleeding, limited cervical spine mobility, or limited cervical spine mobility). Blind intubation using a lighted stylet in these situations is a proven valuable technique.5-14
Light-guided intubation relies on the transillumination of the soft tissue of the neck to indicate intratracheal endotracheal (ET) tube placement. A bright and well-defined glow is seen in the anterior neck when the light is in the trachea (Figures 24-1 and 24-2A). A diffuse and less intense glow is seen with esophageal intubation (Figure 24-2B). Lighted stylet intubation is a relatively easy technique to learn and rapid to perform.
A bright and well-circumscribed glow (arrow) is seen below the thyroid prominence when the lighted stylet enters the glottis. (Used with permission from Hung O, Murphy MF (eds): Management of the Difficult and Failed Airway, 2nd ed. New York: McGraw-Hill; 2012.)
Use of a lighted stylet. A. The tip of the ET tube is in the glottic opening and below the thyroid prominence at the glottic opening. B. The tip of the ET tube is in the esophagus. (Used with permission from Hung O, Murphy MF (eds): Management of the Difficult and Failed Airway, 2nd ed. New York: McGraw-Hill; 2012.)
The concept of using a light-guided introducer for orotracheal intubations first appeared in print in the late 1950s.1,2,5,6 Several authors described ingenious devices to tunnel a light bulb attached to an introducer through the ET tube and power it with a pocket battery, penlight, or laryngoscope handle.1,2,5,6 These primitive devices were simple and effective. Further development of this technology was stagnant until the late 1970s when several authors described use of the Flexilum surgical light as a lighted stylet or “light wand.”7,8 The makers of the Flexilum light revised the design after a few problems with bulb dislodgment and marketed the first lighted stylet known as ...