Newer model Vividtrac test with improvised bougie technique with Dr DuCanto

Jim uses the newly remodelled Vividtrac in a 144kg patient

Prehospital pointers and some general commentary:

1. Please note. A lot of Jim’s patients are elective fasted patients so issues of full stomach and blood and pus in airway are not often encountered. Preoxygenation with the Oxylator or a ventilator is a smart idea in these cases as you can limit the pressure and flow, thereby reducing gastric distension. Its much harder to do that with a manual BVM. Nasal cannula apnoeic oxygenation might help in these large patients during intubation as well but note how with adequate preoxygenation with Oxylator, the SpO2 does not fall below 80% during entire intubation.

2.Note the newer model Vividtrac provides an excellent view of the larynx, which is small and hence Jim has problems passing a 8.0 ETT via the guidechannel. A few things he could have done with an excellent laryngeal view but difficulty passing the tube.

A.use a bougie or in his case an improvised bougie ( esophageal temperature probe), like you would use it normally, and not via the guidechannel

B.use a styletted smaller size ETT in a straight to cuff , hockey stick shape, passing it independent of the Vividtrac which provides video guidance alone.

-Jim as always thinks faster than a supercomputer and solves his tube passage issue with a esophageal probe down the ETT whilst still in the guidechannel of the Vividtrac. This allows the larynx inlet to be negotiated due to smaller diameter of the probe. Brilliant maneuver, Jim!

I recommend A or B aforementioned for those lesser airway masters who dont want more excitement than necessary!

Minh

 

 

5 thoughts on “Newer model Vividtrac test with improvised bougie technique with Dr DuCanto

  1. Interesting video and thanks for sharing.

    VL are brilliant for the obese. In the bariatric lists I’ve done in the past (305kg was my biggest) we used the glidescope. Although, I personally don’t think it matters which one you use as long as you know how to use it. Little evidence to say that any VL is definitively the best.

    My one concern and it maybe related to camera angles, is the apparent lack of ramping and positioning. We would anaesthetise them on the operating table in the beach chair position (good for ramping and later for surgical access from between the legs). Induction in this position improves v/q matching and improves the frc (hopefully above the closing capacity) allowing for better preoxygenation, NIV assisted or not. Plus obviously better grade of larynogoscopy and better chest wall compliance for ventilation post intubation.

    Any intubation=external auditory meatus to sternal notch. Obese=ramp. You never want to fail a tube because of position. BVM ventilation is possible in the obese (usually) but increased inflation pressures required and higher risk of gastric inflation coupled with higher incidence of GORD could lead to bad times!

    Anyway interesting video and I must declare I never used this VL. Plus hats off to the improvised use of an oesophageal probe.

    Peter

    1. thanks Peter. I cant tell from the camera angle if the patient is ramped or not. I presume so. Direct message me on Twitter your mailing address and I will send you a Vividtrac for your own review. Love to hear your thoughts on it!

  2. You are correct, Peter, the patient was not ramped. For proper preparation (to prevent a piss-poor performance), positioning with a ramp support is advised. This is important for both ventilation as well direct laryngoscopy.
    All that being considered, I wanted to make it “hard” on myself to really test the capabilities of this new device. Call me a bit different…. Jim

  3. Peter, you havent seen the video of Jim doing a 160ft chamber dive in the name of anaesthetic research as proof that he is a little it different!
    As if anaesthetising and intubating a 144kg patient is not challenging enough, Jim mixes it up. But absolutely, ramp and position the obese patient as best as you can. Sometimes, though to be fair, you cannot in the prehospital and retrieval setting and you gotta make do with the position you can achieve rather than ideal.

    1. The anaesthetist who is living life on the edge! Good stuff!

      On the pre hospital side of things in obese patients. Ramped position is difficult but if they are on a scoop or long board you can put the head up portion of the ambo stretcher to 30+ degrees or so and maintain spinal precautions. You effectively get a reverse trendelenberg which is better then flat on their back! Every little helps!

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