Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethics
2.2. Participants
2.3. Interventions
2.4. Measurement
2.5. Outcomes
2.6. Sample Size
2.7. Trial Design, Randomization, and Blinding
2.8. Statistical Methods
3. Results
3.1. Demographic Characteristics
3.2. Cervical Spine Motion
3.3. Intubation Performance
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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ELM First (n = 14) | ELM Second (n = 13) | |
---|---|---|
Demographic data | ||
Male sex | 6 (42.9%) | 4 (30.8%) |
Age (year) | 56.7 ± 8.7 | 60.3 ± 12.3 |
Height (cm) | 163.8 ± 10.5 | 160.6 ± 6.4 |
Weight (kg) | 67.4 ± 17.6 | 63.8 ± 7.1 |
Body mass index (kg m−2) | 24.2 (21.4 to 26.0) | 23.4 (22.3 to 27.3) |
ASA physical status | ||
I | 4 (28.6%) | 2 (15.4%) |
II | 5 (35.7%) | 10 (76.9%) |
III | 5 (35.7%) | 1 (7.7%) |
Airway-related data | ||
Mallampati class | ||
I | 3 (21.4%) | 4 (30.8%) |
II | 5 (35.7%) | 3 (23.1%) |
III | 5 (35.7%) | 6 (46.2%) |
IV | 1 (7.1%) | 0 (0.0%) |
Interincisor gap (cm) | 4.8 (4.0 to 5.0) | 5.0 (4.0 to 5.3) |
Thyromental distance (cm) | 8.5 (8.0 to 9.0) | 9.0 (8.0 to 9.0) |
Sternomental distance (cm) | 16.0 (15.0 to 16.5) | 16.0 (15.5 to 18.5) |
Neck circumference (cm) | 36.5 (33.5 to 40.5) | 35.0 (34.0 to 36.0) |
With ELM | Without ELM | Mean Difference (98.33% CI) | p-Value | |
---|---|---|---|---|
Total patients (n = 27) | ||||
Occiput–C1 (°) | 7.4 ± 4.6 | 11.5 ± 4.8 | −4.1 (−5.8 to −2.3) | <0.001 |
C1–C2 (°) | 5.7 ± 4.1 | 4.7 ± 3.5 | 1.0 (−1.1 to 3.0) | 0.244 |
C2–C5 (°) | −0.9 ± 4.4 | 1.3 ± 4.4 | −2.2 (−4.8 to 0.4) | 0.040 |
C4–C5 (°) | −0.4 ± 1.9 | −0.8 ± 2.2 | 0.4 (−0.7 to 1.6) | 0.343 |
Patients whose first POGO score was reproduced in second attempt (n = 20) | ||||
Occiput–C1 (°) | 8.0 ± 4.9 | 11.8 ± 4.5 | −3.8 (−6.0 to −1.6) | <0.001 |
C1–C2 (°) | 6.1 ± 4.3 | 4.9 ± 3.5 | 1.2 (−1.3 to 3.7) | 0.229 |
C2–C5 (°) | −1.8 ± 4.5 | 0.7 ± 4.7 | −2.5 (−5.9 to 0.8) | 0.064 |
C4–C5 (°) | −0.5 ± 1.9 | −1.0 ± 2.2 | 0.5 (−0.8 to 1.7) | 0.356 |
Patients whose first POGO score was not reproduced in second attempt (n = 7) | ||||
Occiput–C1 (°) | 5.7 ± 3.2 | 10.6 ± 6.0 | −4.9 (−9.1 to −0.7) | 0.008 |
C1–C2 (°) | 4.4 ± 3.2 | 4.1 ± 3.4 | 0.3 (−4.9 to 5.5) | 0.850 |
C2–C5 (°) | 1.6 ± 3.1 | 2.9 ± 2.8 | −1.3 (−6.3 to 3.7) | 0.433 |
C4–C5 (°) | 0.1 ± 2.1 | −0.4 ± 2.2 | 0.4 (−3.6 to 4.4) | 0.740 |
With ELM | Without ELM | Effect Size * (95% CI) | p-Value | |
---|---|---|---|---|
Total patients (n = 27) | ||||
Intubation success | 27 (100%) | 27 (100%) | Not applicable | 1.000 |
Intubation time (s) | 33.0 (25.0 to 43.0) | 26.0 (20.0 to 35.0) | 6.5 (3.0 to 11.0) | 0.002 |
POGO score (%) | 59.3 ± 28.0 | 52.4 ± 31.8 | 6.9 (0.2 to 13.5) | 0.044 |
Patients whose first POGO score was reproduced in second attempt (n = 20) | ||||
Intubation success | 20 (100%) | 20 (100%) | Not applicable | 1.000 |
Intubation time (s) | 32.0 (24.3 to 42.5) | 26.0 (18.5 to 33.0) | 7.0 (3.5 to 11.5) | 0.001 |
POGO score (%) | 61.0 ± 29.4 | 61.0 ± 29.4 | Not applicable | 1.000 |
Patients whose first POGO score was not reproduced in second attempt (n = 7) | ||||
Intubation success | 7 (100%) | 7 (100%) | Not applicable | 1.000 |
Intubation time (s) | 37.0 (28.0 to 56.0) | 26.0 (24.0 to 43.0) | 4.5 (−11.0 to 20.5) | 0.499 |
POGO score (%) | 54.3 ± 25.1 | 27.9 ± 26.4 | 26.4 (3.4 to 49.5) | 0.031 |
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Kim, Y.J.; Hur, C.; Yoon, H.-K.; Lee, H.-C.; Park, H.-P.; Oh, H. Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial. J. Clin. Med. 2021, 10, 2931. https://doi.org/10.3390/jcm10132931
Kim YJ, Hur C, Yoon H-K, Lee H-C, Park H-P, Oh H. Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial. Journal of Clinical Medicine. 2021; 10(13):2931. https://doi.org/10.3390/jcm10132931
Chicago/Turabian StyleKim, Yoon Jung, Chahnmee Hur, Hyun-Kyu Yoon, Hyung-Chul Lee, Hee-Pyoung Park, and Hyongmin Oh. 2021. "Effects of External Laryngeal Manipulation on Cervical Spine Motion during Videolaryngoscopic Intubation under Manual In-Line Stabilization: A Randomized Crossover Trial" Journal of Clinical Medicine 10, no. 13: 2931. https://doi.org/10.3390/jcm10132931