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Cited by 86Airway Management and Intubation TechniquesRestraint-Related DeathsTracheal and airway disorders

Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial

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Thiboutot, François, Nicole, Pierre C., Trépanier, Claude A., Turgeon, Alexis F., Lessard, Martin R.·2009·Canadian Journal of Anesthesia/Journal canadien d'anesthésie
DOI 10.1007/s12630-009-9089-7
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Abstract

Purpose Although manual in-line stabilization (MILS) is commonly used during endotracheal intubation in patients with either known or suspected cervical spine instability, the effect of MILS on orotracheal intubation is poorly documented. This study evaluated the rate of failed tracheal intubation in a fixed time interval with MILS. Methods Two hundred elective surgical patients were randomized into two groups. In the MILS group, the patient's head was stabilized in a neutral position by grasping the patient's mastoid processes to minimize any head movement during tracheal intubation. In the control group, the patient's head rested in an optimal position for tracheal intubation. A 30-sec period was allowed to complete tracheal intubation with a #3 Macintosh laryngoscope blade. The primary endpoint was the rate of failed tracheal intubation at 30 sec. Secondary endpoints included tracheal intubation time and the Cormack & Lehane grade of laryngoscopy. Results Patient characteristics were similar with respect to demographic data and risk factors for difficult tracheal intubation. The rate of failed tracheal intubation at 30 sec was 50% (47/94) in the MILS group compared to 5.7% (6/105) in the control group (P < 0.0001). Laryngoscopic grades 3 and 4 were more frequently observed in the MILS group. Mean times for successful tracheal intubation were 15.8 +/- 8.5 sec and 8.7 +/- 4.6 sec for the MILS and control groups, respectively (mean difference 7.1, CI(95%) 5.0-9.3, P < 0.0001). All patients who failed tracheal intubation in the MILS group were successfully intubated when MILS was removed. Conclusion In patients with otherwise normal airways, MILS increases the tracheal intubation failure rate at 30 sec and worsens laryngeal visualization during direct laryngoscopy.

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  • Manual inline stabilization (MILS) worsens the view obtained with DL in up to 50% of cases.

    “Manual inline stabilization (MILS) worsens the view obtained with DL in up to 50% of cases.40”

    From Airway Management in Trauma (2018) · cites this paper as [40]

    The Abstract and Discussion report that MILS worsened laryngeal visualization during direct laryngoscopy. But the Abstract’s 50% figure is the rate of failed intubation within 30 seconds in the MILS group, not the proportion of cases in which the view worsened. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Application of MILS results in the need for an increased applied force during laryngoscopy, which paradoxically may lead to more movement during intubation than occurs without MILS.

    “Another theoretic concern is that application of MILS results in the need for an increased applied force during laryngoscopy, which paradoxically may lead to more movement during intubation than occurs without MILS.40,41”

    From Airway Management in Trauma (2018) · cites this paper as [40]

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Research works printed but not linked: 33

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Authors
Thiboutot, F., Nicole, P. C., Trépanier, C. A., Turgeon, A. F., & Lessard, M. R.
Affiliations
Hôpital de l'Enfant-Jésus (CA)
Corresponding author
Lessard, Martin R.
ORCID
Turgeon, Alexis F.
Venue
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Publisher
Springer Science and Business Media LLC
Published
2009-04-24
Volume
56
Issue
6
Pages
412-418
ISSN
  • 0832-610X (ISSN-L)
  • 1496-8975
DOI
10.1007/s12630-009-9089-7
OpenAlex
W1554846927
Cited by
86
References
0
Citations by year
2026: 4 · 2025: 2 · 2024: 4 · 2023: 5 · 2022: 8 · 2021: 9 · 2020: 2 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 7 · 2014: 7 · 2013: 4 · 2012: 3
FWCI
5.60
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
  • Health Sciences › Medicine › Emergency Medicine › Restraint-Related Deaths
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Tracheal and airway disorders
Keywords
manual in-line stabilization, cervical spine immobilization, difficult intubation, failed intubation, direct laryngoscopy, Cormack-Lehane grade, laryngeal visualization, intubation time, elective surgery patients, airway management
MeSH terms
Adult, Cervical Vertebrae, Clinical Protocols, Female, Humans, Immobilization, Intubation, Intratracheal, Laryngoscopy, Male, Middle Aged, Pressure, Risk Factors, Time Factors, Treatment Failure

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