{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T13:51:16Z","timestamp":1762782676298,"version":"3.41.2"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T00:00:00Z","timestamp":1639526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Tracheal intubation in patients with an expected difficult airway may be facilitated by videolaryngoscopy (VL). The VL viewing axis angle is specified by the blade shape and visualization of the larynx may fail if the angle does not meet anatomy of the patient. A tube with an integrated camera at its tip (VST, VivaSight-SL) may be advantageous due to its adjustable viewing axis by means of angulating an included stylet.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> With ethics approval, we studied the VST vs. VL in a prospective non-inferiority trial using end-tidal oxygen fractions (etO<jats:sub>2<\/jats:sub>) after intubation, first-attempt success rates (FAS), visualization assessed by the percentage of glottis opening (POGO) scale, and time to intubation (TTI) as outcome parameters.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In this study, 48 patients with a predicted difficult airway were randomized 1:1 to intubation with VST or VL. Concerning oxygenation, the VST was non-inferior to VL with etO<jats:sub>2<\/jats:sub> of 0.79 \u00b1 0.08 (95% CIs: 0.75\u20130.82) vs. 0.81 \u00b1 0.06 (0.79\u20130.84) for the VL group, mean difference 0.02 (\u22120.07 to 0.02), <jats:italic>p<\/jats:italic> = 0.234. FAS was 79% for VST and 88% for VL (<jats:italic>p<\/jats:italic> = 0.449). POGO was 89 \u00b1 21% in the VST-group and 60 \u00b1 36% in the VL group, <jats:italic>p<\/jats:italic> = 0.002. TTI was 100 \u00b1 57 s in the VST group and 68 \u00b1 65 s in the VL group (<jats:italic>p<\/jats:italic> = 0.079). TTI with one attempt was 84 \u00b1 31 s vs. 49 \u00b1 14 s, <jats:italic>p<\/jats:italic> &amp;lt; 0.001.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> In patients with difficult airways, tracheal intubation with the VST is feasible without negative impact on oxygenation, improves visualization but prolongs intubation. The VST deserves further study to identify patients that might benefit from intubation with VST.<\/jats:p>","DOI":"10.3389\/fmed.2021.767182","type":"journal-article","created":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T09:10:30Z","timestamp":1639559430000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Tracheal Tube-Mounted Camera Assisted Intubation vs. Videolaryngoscopy in Expected Difficult Airway: A Prospective, Randomized Trial (VivaOP Trial)"],"prefix":"10.3389","volume":"8","author":[{"given":"J\u00f6rn","family":"Grensemann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"M\u00f6hlenkamp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Breitfeld","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pischtaz A.","family":"Tariparast","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanja","family":"Peters","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark A.","family":"Punke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Kluge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Petzoldt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1007\/s00063-018-0498-7","article-title":"Airway management in intensive care and emergency medicine: what is new?","volume":"114","author":"Grensemann","year":"2019","journal-title":"Med Klin Intensivmed Notfmed."},{"unstructured":"S1 Guideline Airwaymanagement, AWMF-Register No. 001\/028\n            PiephoT\n            CavusE\n            NoppensR\n            ByhahnC\n            D\u00f6rgesV\n            ZwisslerB\n          2015","key":"B2"},{"key":"B3","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1111\/anae.14904","article-title":"Difficult airway society guidelines for awake tracheal intubation (ATI) in adults","volume":"75","author":"Ahmad","year":"2020","journal-title":"Anaesthesia."},{"key":"B4","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1093\/bja\/aev371","article-title":"Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults","volume":"115","author":"Frerk","year":"2015","journal-title":"Br J Anaesth."},{"key":"B5","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1093\/bja\/aeq024","article-title":"ETView tracheoscopic ventilation tube for surveillance after tube position in patients undergoing percutaneous nephrolithotomy","volume":"104","author":"Barak","year":"2010","journal-title":"Br J Anaesth."},{"key":"B6","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1186\/s13054-018-2152-4","article-title":"Endotracheal tube-mounted camera-assisted intubation versus conventional intubation in intensive care: a prospective, randomised trial (VivaITN)","volume":"22","author":"Grensemann","year":"2018","journal-title":"Crit Care."},{"key":"B7","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1471-2253-14-31","article-title":"The use of VivaSight single lumen endotracheal tube in morbidly obese patients undergoing laparoscopic sleeve gastrectomy","volume":"14","author":"Barak","year":"2014","journal-title":"BMC Anesthesiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1093\/bja\/aew057","article-title":"Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants","volume":"116","author":"Norskov","year":"2016","journal-title":"Br J Anaesth."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1213\/00000539-199606000-00017","article-title":"Preoperative airway assessment: predictive value of a multivariate risk index","volume":"82","author":"el-Ganzouri","year":"1996","journal-title":"Anesth Analg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1001\/jama.2018.21413","article-title":"Will this patient be difficult to intubate?","volume":"321","author":"Detsky","year":"2019","journal-title":"JAMA."},{"key":"B11","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1213\/00000539-200302000-00053","article-title":"A comparison of the upper lip bite test (a simple new technique) with modified mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study","volume":"96","author":"Khan","year":"2003","journal-title":"Anesth Analg."},{"key":"B12","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.eclinm.2019.05.014","article-title":"High-flow nasal cannulae versus non-invasive ventilation for preoxygenation of obese patients: the PREOPTIPOP randomized trial","volume":"13","author":"Vourc'h","year":"2019","journal-title":"EClinicalMedicine."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1111\/j.1365-2044.1984.tb08932.x","article-title":"Difficult tracheal intubation in obstetrics","volume":"39","author":"Cormack","year":"1984","journal-title":"Anaesthesia."},{"key":"B14","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1111\/j.1553-2712.1998.tb02823.x","article-title":"Assessment of airway visualization: validation of the percentage of glottic opening (POGO) scale","volume":"5","author":"Levitan","year":"1998","journal-title":"Acad Emerg Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1213\/ANE.0b013e31827b278f","article-title":"A feasibility study using the VivaSight single lumen to intubate the trachea through the fastrach laryngeal mask airway: a preliminary report of 50 cases","volume":"116","author":"Gaitini","year":"2013","journal-title":"Anesth Analg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1111\/anae.12065","article-title":"Tracheal intubation with a camera embedded in the tube tip (Vivasight)","volume":"68","author":"Huitink","year":"2013","journal-title":"Anaesthesia."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e5873","DOI":"10.1097\/MD.0000000000005873","article-title":"Comparison of the ETView single lumen and macintosh laryngoscopes for endotracheal intubation in an airway manikin with immobilized cervical spine by novice paramedics: a randomized crossover manikin trial","volume":"96","author":"Gawlowski","year":"2017","journal-title":"Medicine."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e850","DOI":"10.1097\/MD.0000000000000850","article-title":"Can the ETView VivaSight SL rival conventional intubation using the macintosh laryngoscope during adult resuscitation by novice physicians?","volume":"94","author":"Kurowski","year":"2015","journal-title":"Medicine."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1016\/j.ajem.2015.04.078","article-title":"A comparison of the ETView VivaSight SL against a fiberoptic bronchoscope for nasotracheal intubation of multitrauma patients during resuscitation. A randomized, crossover, manikin study","volume":"33","author":"Truszewski","year":"2015","journal-title":"Am J Emerg Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1016\/j.ajem.2016.02.054","article-title":"Comparison of the VivaSight single lumen endotracheal tube and the macintosh laryngoscope for emergency intubation by experienced paramedics in a standardized airway manikin with restricted access: a randomized, crossover trial","volume":"34","author":"Truszewski","year":"2016","journal-title":"Am J Emerg Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"274","DOI":"10.5603\/AIT.a2017.0047","article-title":"ET-View compared to direct laryngoscopy in patients with immobilized cervical spine by unexperienced physicians: a randomized crossover manikin trial","volume":"49","author":"Karczewska","year":"2017","journal-title":"Anaesthesiol Intensive Ther."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e5170","DOI":"10.1097\/MD.0000000000005170","article-title":"A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: a randomized, crossover cadaver trial","volume":"95","author":"Truszewski","year":"2016","journal-title":"Medicine."},{"key":"B23","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1111\/aas.12904","article-title":"Feasibility of an endotracheal tube-mounted camera for percutaneous dilatational tracheostomy","volume":"61","author":"Grensemann","year":"2017","journal-title":"Acta Anaesthesiol Scand."},{"key":"B24","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1186\/s13054-017-1901-0","article-title":"Bronchoscopy versus an endotracheal tube mounted camera for the peri-interventional visualization of percutaneous dilatational tracheostomy - a prospective, randomized trial (VivaPDT)","volume":"21","author":"Grensemann","year":"2017","journal-title":"Crit Care."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1111\/anae.14299","article-title":"Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: a systematic review and meta-analysis","volume":"73","author":"Alhomary","year":"2018","journal-title":"Anaesthesia."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1836","DOI":"10.1056\/NEJMra1916801","article-title":"Management of the difficult airway","volume":"384","author":"Heidegger","year":"2021","journal-title":"N Engl J Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1046\/j.1365-2044.2000.01270.x","article-title":"A new practical classification of laryngeal view","volume":"55","author":"Cook","year":"2000","journal-title":"Anaesthesia."},{"key":"B28","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1111\/anae.15446","article-title":"Making the grade: has cormack and lehane grading stood the test of time?","volume":"76","author":"Pearce","year":"2021","journal-title":"Anaesthesia."},{"key":"B29","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1213\/ANE.0000000000004442","article-title":"McGrath MAC videolaryngoscope versus optiscope video stylet for tracheal intubation in patients with manual inline cervical stabilization: a randomized trial","volume":"130","author":"Yoon","year":"2020","journal-title":"Anesth Analg."},{"key":"B30","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1097\/ALN.0b013e3182023eb7","article-title":"Routine clinical practice effectiveness of the glidescope in difficult airway management: an analysis of 2,004 glidescope intubations, complications, and failures from two institutions","volume":"114","author":"Aziz","year":"2011","journal-title":"Anesthesiology."},{"key":"B31","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1093\/bja\/aew058","article-title":"Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial","volume":"116","author":"Kleine-Brueggeney","year":"2016","journal-title":"BJA."},{"key":"B32","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1016\/j.jemermed.2011.05.019","article-title":"Tracheal intubation in the emergency department: a comparison of GlideScope\u00ae video laryngoscopy to direct laryngoscopy in 822 intubations","volume":"42","author":"Sakles","year":"2012","journal-title":"J Emerg Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.resuscitation.2015.11.005","article-title":"Defining the learning curve for endotracheal intubation using direct laryngoscopy: a systematic review","volume":"99","author":"Buis","year":"2016","journal-title":"Resuscitation."},{"key":"B34","doi-asserted-by":"publisher","first-page":"i60","DOI":"10.1093\/bja\/aew061","article-title":"Strategies to improve first attempt success at intubation in critically ill patients","volume":"117","author":"Natt","year":"2016","journal-title":"Br J Anaesth."},{"key":"B35","first-page":"81","article-title":"Airway challenges in critical care","volume-title":"Anaesthesia.","author":"Nolan","year":"2011"},{"key":"B36","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1111\/j.1365-2044.2007.05104.x","article-title":"Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation","volume":"62","author":"Baraka","year":"2007","journal-title":"Anaesthesia."},{"key":"B37","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1007\/s12630-021-01921-7","article-title":"A systematic review of meta-analyses comparing direct laryngoscopy with videolaryngoscopy","volume":"68","author":"Downey","year":"2021","journal-title":"Can J Anaesth."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.767182\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T09:10:36Z","timestamp":1639559436000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.767182\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,15]]},"references-count":37,"alternative-id":["10.3389\/fmed.2021.767182"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.767182","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2021,12,15]]},"article-number":"767182"}}