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This may lead to repeated intubation attempts, possible trauma, possible failed intubation and hypoxia if alternative ventilation is not ensured. In this prospective observational study, we investigated the effectiveness of tracheal intubation without impingement over a guidewire already in place. Our direct wire-guided intubation system consists of a modified reinforced silicone tracheal tube with a guide channel in its wall to accommodate a matched kink-resistant guidewire as the introducer. We studied 299 American Society of Anesthesiologists Physical Status classification 1\u20133 patients with a predicted low risk of difficult intubation. Significant impingement occurred in one patient due to a deep laryngeal fissure (0.3%, upper limit of 95% confidence interval 1.9%). Laryngeal tube transit was graded \u2018not difficult\u2019 in 284 patients (95%), and \u2018mildly difficult\u2019 in 14 (4.7%). Tube transit between oropharynx and glottis offered no resistance in 294 patients (98.3%) and mild resistance in five (1.7%). There were no oesophageal misplacements of the tube. Our system appears effective to facilitate guidewire-assisted tracheal intubation in patients at predicted low risk of difficult intubation when a guidewire is already in place. Further studies are required in patients with predicted difficult intubation.<\/jats:p>","DOI":"10.1177\/0310057x251377301","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T08:54:42Z","timestamp":1760432082000},"page":"31-41","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of a direct wire-guided intubation system to secure tracheal intubation: A prospective observational study"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2898-6419","authenticated-orcid":false,"given":"Michael J","family":"Challis","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Australia"},{"name":"School of Medicine, University of Tasmania, Hobart, 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