Thread by @NorthwickNEO

The Video Classification of Intubation (VCI) score: a new description tool for tracheal #intubation using #videolaryngoscopy. A Tweetorial on #VCI 1/15 @R_S_Chaggar @LondonSneh Michael Berry Rajan Saini @sanooj_soni @oldandbaffled @EJA_Journal journals.lww.com/ejanaesthesiol…

Tracheal intubation using VL is prevalent, yet a classification & documentation tool has not been widely adopted into clinical practice. We have developed the #VCI score & assessed its validity & reproducibility in manikins & patients. 2/15

We investigated whether 2 anaesthetists could generate congruent #VCI scores for a given patient. The VCI scores recorded by each anaesthetist were identical in 34/35 (97.1%) patients. 3/15

The #VCI score describes 3 key components in the order in which they are performed: the generic videolaryngoscope blade shape used; the glottic view at which tracheal intubation was successful or attempted; and the ease of tracheal intubation. 4/15

#VCI score 1/3: Shape of the videolaryngoscope blade used – either ‘M’ for Macintosh blade or ‘D’ for hyperangulated blade often used for ‘difficult’ #videolaryngoscopy. Familiarity with the name/version of the growing number of devices available is not needed. 5/15

#VCI score 2/3: Percentage of glottic opening (POGO) is recorded as 0, 25, 50, 75 or 100%, specifically at the moment of intubation. This is a crucial nuance since glottic view at which successful tracheal intubation is achieved ≠ initial or best view obtained. 6/15

#VCI score 3/3: Ease of intubation is described as easy (E), difficult (D) or failed (F). An ‘easy’ intubation is straightforward with no modifications or as per manufacturers recommendations (e.g. preformed stylet with an hyperangulated blade). 7/15

A ‘difficult’ #intubation requires manipulation of the tracheal tube with additional equipment and maybe a consequence of anatomical, physiological or environmental factors. Further info detailing the technique attempted should be provided. 8/15

E.g. D50D (Flextip bougie) = #intubation using a hyperangulated blade where 50% of the glottic opening was visible at the moment of intubation and a Flextip bougie was required to enable passage of the tracheal tube. 9/15

A ‘failed’ intubation is an unsuccessful attempt despite using extra equipment or, due to encountering difficulties (e.g. tracheal stenosis). 10/15

We investigated whether 2 anaesthetists could generate congruent #VCI scores for a given patient. The VCI scores recorded by each anaesthetist were identical in 34/35 (97.1%) patients. 11/15

Absence of universally accepted tool -> clinicians using substitutes. C&L grading is unhelpful for VL - it describes the direct, glottic view achieved by aligning the oral-pharyngeal-laryngeal axes. ⬆️ difficulty with direct view tracheal intubation = a higher CL grade. 12/15

Glottic view during VL is obtained from a camera positioned near blade tip -> indirect view since the 3 axes need not be aligned. For this reason, the glottic view obtained by VL does not necessarily = ease of tracheal #intubation. 13/15

The need to succinctly communicate about #airway management has become ⬆️ apparent during this pandemic (transfers, proning, tracheostomy tube insertion). Clear communication allows the necessary caution & preparation to be exercised when managing patients’ airways. 14/15

We hope ⬆️ people will adopt the #VCI score for communicating & documenting tracheal #intubation using #videolaryngoscopy & thereby ⬇️ the potential for harm from miscommunication about #airway management. 15/15