A comparison of conventional tube and EndoFlex tube for tracheal intubation in patients with a
cervical spine immobilisation
Sammanfattning
Background
The EndoFlex is a new type of tracheal tube with an adjustable distal tip that can be bent without the
use of a stylet. The aim of this study was to compare a standard endotracheal tube with the EndoFlex
tracheal tube for intubation in patients with simulated cervical spine injury.
Methods
A group of 60 patients without any kind of the cervical spine injury, classified as the ASA
physiological scale I or II and qualified for elective surgery procedures were intubated with the use of
classical Macintosh laryngoscope, and either a standard endotracheal tube with the intubation stylet
in it or EndoFlex tube without stylet. The subjects were randomized into two subgroups. All patients
have had the cervical collar placed on their neck for the simulation of intubation procedure in case of
the spinal injury.
Results
The intubation procedure was performed by 16 anesthetists with different experience (5-19 yrs). Time
of intubation with the use of EndoFlex tube was similar to that with a the use of standard endotracheal
tube and intubation stylet: Me (median) 19.5 s [IQR (interquatile range) 18-50] vs. Me 20 s [IQR 17-60]
respectively (p = 0.9705). No significant additional maneuvers were necessary during intubation with
the use of EndoFlex tube in comparison with standard endotracheal tube (70% vs. 56.6%) (p =
0.4220). Subjective assessment of the usability of both tubes revealed that more anesthesiologists
found intubations with the use of EndoFlex more demanding than intubation with conventional
tracheal tube and intubation stylet. The assessment of usability: very easy 3.3% vs. 20%, easy
83.4% vs. 56.7%, difficult 10% vs. 20% and very difficult 3.3% vs. 3.3% for standard endotracheal tube
with stylet and EndoFlex, respectively.
Conclusion
In conclusion we asses, that the EndoFlex tube does not improve intubation success rate, in fact it
requires more maneuvers facilitating intubation and was found to be more difficult to use.