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BACKGROUND: The role of gastroesophageal reflux in progressive lung damage is increasingly recognized. We have proposed, based on our work with lung transplant recipients, a novel immune mechanism of pulmonary injury after aspiration of gastric contents, during which higher levels of normally sequestered lung self-antigens (SAgs) collagen V (Col-V) and K-alpha-1 tubulin (Kα1T) in circulating small extracellular vesicles (EVs) induce the production of self-antibodies (SAbs) anti-Col-V and anti-Kα1T. Thus, we aimed to determine whether levels of SAbs or SAgs increased in an animal model of aspiration-induced lung damage in a nontransplant setting. METHODS: We created a murine model of repetitive lung aspiration using C57BL/6J mice. Mice were aspirated weekly with 1 mL/kg of hydrochloric acid (n = 9), human gastric contents (n = 9), or combined (1:1) fluid (n = 9) once, three, or six times (n = 3 in each subgroup; control group, n = 9). Blood samples were periodically obtained, and all animals were sacrificed at day 90 for pathological assessment. SAbs were measured using an enzyme-linked immunosorbent assay; SAgs and NF-κB contained in small EVs were assessed by western blot. RESULTS: Aspirated mice weighed significantly less than controls throughout the study and had histological evidence of pulmonary injury at day 90. Overall, aspirated mice developed higher concentrations of anti-Col-V at day 28 (53.9 ± 28.7 vs. 29.9 ± 4.5 ng/mL, p < 0.01), day 35 (42.6 ± 19.8 vs. 28.6 ± 7.2 ng/mL, p = 0.038), and day 90 (59.7 ± 27.7 vs. 34.1 ± 3.2 ng/mL, p = 0.014) than the control group. Circulating small EVs isolated from aspirated mice on day 90 contained higher levels of Col-V (0.7 ± 0.56 vs. 0.18 ± 0.6 m.o.d., p = 0.009) and NF-κB (0.42 ± 0.27 vs. 0.27 ± 0.09 m.o.d., p = 0.095) than those from controls. CONCLUSIONS: This experimental study supports the theory that gastroesophageal reflux leads to the development of lung damage and an increase of humoral markers that may serve as noninvasive biomarkers to detect asymptomatic lung injury among patients with gastroesophageal reflux disease.

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Objective: Hyoid bone movement is potentially related to aspiration risk in post-stroke dysphagia (PSD) patients but is difficult to assess quantitatively. This study aimed to measure the distance of hyoid bone movement more efficiently and accurately using a deep learning model and determine the clinical usefulness of the model in PSD patients. Methods: This study included 85 patients with PSD within 6 months from onset. Patients were grouped into an aspiration group (n = 35) and a non-aspiration group (n = 50) according to the results of a videofluoroscopic swallowing study. Hyoid bone movement was tracked using a deep learning model constructed with the BiFPN-U-Net(T) architecture. The maximum distance of hyoid bone movement was measured horizontally (H max), vertically (V max), and diagonally (D max). Results: Compared with the non-aspiration group, the aspiration group showed significant decreases in hyoid bone movement in all directions. The area under the curve of V max was highest at 0.715 with a sensitivity of 0.680 and specificity of 0.743. The V max cutoff value for predicting aspiration risk was 1.61 cm. The success of oral feeding at the time of discharge was significantly more frequent when hyoid movement was equal to or larger than the cutoff value although no significant relationship was found between hyoid movement and other clinical characteristics. Conclusion: Hyoid bone movement of PSD patients can be measured quantitatively and efficiently using a deep learning model. Deep learning model-based analysis of hyoid bone movement seems to be useful for predicting aspiration risk and the possibility of resuming oral feeding.

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Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.

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For the elderly, the risks associated with pulmonary aspiration are significant, and can severely impact their quality of life. Therefore, the management of pulmonary aspiration risk is crucial in promoting healthy aging, an aspect often overlooked in self-health management for the elderly. To enhance self-management of pulmonary aspiration risk among the elderly, we have organized a multidisciplinary team to develop an intelligent risk hierarchical management system on pulmonary aspiration for the elderly. This system tailors the assessment with different questionnaires based on the elderly individual's environment. Additionally, it utilizes elderly-friendly formats such as pictures, videos and animations, making it easier for seniors to comprehend the occurrence and hazards of pulmonary aspiration. This enables them to proactively take preventive measures to manage the risk, thus achieving self-management of pulmonary aspiration risk.

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INTRODUCTION: Ingestion of gasoline can cause severe pulmonary and gastrointestinal complications. Computed tomography may reveal characteristic findings. CASE SUMMARY: A 61-year-old man had gastrointestinal symptoms, and subsequently developed respiratory distress and altered mental status after ingesting approximately 150 mL of gasoline. IMAGES: Abdominal computed tomography revealed a characteristic three-layered appearance of intestinal contents, likely representing intestinal fluid, ingested gasoline, and gas. Chest computed tomography showed bilateral pulmonary infiltrates consistent with pneumonitis. CONCLUSION: Recognition of the characteristic three-layered appearance of the intestinal contents on abdominal computed tomography might aid in the diagnosis of gasoline ingestion.

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BACKGROUND: The literature associates clozapine with pneumonia/aspiration pneumonia. RESEARCH DESIGN AND METHODS: The international pharmacovigilance database (VigiBase™) uses the information component (IC) as statistical signal. VigiBase clozapine reports were analyzed for pneumonia/aspiration pneumonia from introduction to 10 May 2023. RESULTS: There were 6392 cases of all types of pneumonia (5572 cases of pneumonia, 775 of aspiration pneumonia, and 45 combined). The IC was 3.52 for aspiration pneumonia, introduced as a VigiBase label in 2003, and 1.91 for pneumonia. Patients were reclassified as 3628 with no signs of aspiration and 1533 with signs. Signs of aspiration were strongly associated with some co-medications: olanzapine, odds ratio (OR) = 23.8, 95% confidence interval (CI), 14.9-38.0; risperidone OR = 18.6, CI, 11.4-30.4; valproic acid, OR = 5.5, CI, 4.5-6.6; and benzodiazepines OR = 5.5, CI, 4.5-6.6. In 2415 cases with completed data, fatal outcomes made up 45% (signs of aspiration made no difference), but there was wide variability from 0% (females <45 years of age; duration ≤30 days) to 76% (males >64 years of age; duration >1 year). During the first week, pneumonia was associated with 1) very high titration doses, 2) very small doses in Parkinson's disease, and 3) Japan vs other countries. CONCLUSIONS: In clozapine-treated patients: 1) at least 30% of pneumonia cases may be aspiration pneumonia, 2) stopping some co-medications may decrease the risk of aspiration pneumonia, 3) average lethality in pneumonia was 45% but may be around 75% in geriatric patients with long-term treatment, and 4) safer titrations may sometimes require 5-mg tablets.

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Background: We investigated factors affecting the low- and high-risk groups for aspiration by measuring gastric volume with ultrasound in diabetic patients who fasted for elective surgery. Methods: The study was conducted as an observational study. Sixty-five patients scheduled for elective surgery, aged 18-86 years, with American Society of Anesthesiologists (ASA) scores II-III, and who have diabetes were included after local ethics committee approval. Written informed consent was obtained from all participants. Demographic data of cases were recorded. Patients whose gastric residual volume (GRV) was calculated using the pupils equal, round, reactive to light, and accommodation (PERLA) formula following gastric antrum measurement in the right lateral decubitus and supine position by ultrasound were categorized as low or high risk for aspiration. Results: Thirty-one patients were in the low-risk group, and 34 patients were in the high-risk group. Sex, weight, body mass index (BMI), hemoglobin A1c (HbA1c) values, and duration of diabetes were not statistically significant (p > 0.5). Age (p = 0.006) and fasting blood glucose (FBG) (p = 0.005) were statistically significant. The risk of aspiration decreases with age. Hyperglycemia is related to delayed gastric emptying and a high risk for aspiration. The duration of fasting, GRV, and cross-sectional area (CSA) were statistically significant (p = 0.017, p = 0.000, and p = 0.000, respectively). Conclusion: Gastric emptying might be delayed in diabetic patients resulting in a high risk for aspiration pneumonia. The risk of aspiration increases in young diabetic patients, and preoperative FBG measurements can provide an idea about gastric emptying in diabetic patients. Gastric ultrasound (USG) may contribute to guidelines for determining more appropriate fasting times for other patient populations, such as obese, pregnant, or child patients.

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To investigate the validity and reliability of the Practical Assessment of Dysphagia (PAD) test as a quantitative and organ-specific test for stroke patients. In this study, PAD test data from 109 patients with stroke were used. The internal consistency of the PAD was analyzed using Cronbach's α value. Inter- and intra-rater reliabilities of the PAD were analyzed using Kappa coefficient. Concurrent validity was evaluated based on the correlation between PAD and the videofluoroscopic swallowing study (VFSS). The diagnostic accuracy of the PAD test in patients with stroke was measured using the area under the receiver operating characteristic (ROC) curve. Intra- and inter-rater reliabilities (Intra-class Correlation Coefficient (ICC) = 0.98 and 0.99, respectively) were significant (p < 0.001) for the total PAD score. The functional dysphagia scale (FDS) score and penetration-aspiration score (PAS) correlated significantly with PAD (p < 0.001). The results of the ROC curve analysis with various cut-off points showed that the PAD test had high sensitivity and specificity. The PAD has high reliability and validity. Therefore, it is a useful screening test for dysphagia in patients with stroke.

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BACKGROUND: Aspiration is a common complication of poststroke dysphagia (PSD) and is associated with poor prognosis and mortality. There is no uniform criterion for determining aspiration associated with dysphagia. The aim of this study was to identify early predictors of aspiration, leading to the development of a simple nomogram for identifying aspiration risk associated with dysphagia in hospitalized patients after stroke. METHODS: Demographic information and clinical characteristics of 330 patients with PSD in the training cohort were utilized to develop a nomogram. The LASSO regression method was used to screen variables, and logistic regression was used to construct the nomogram. Internal validation was performed with bootstrap in the training cohort, and external validation was performed in the validation cohort of another 82 patients. The area under the curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. RESULTS: Seven variables were selected based on LASSO and multivariate logistic regression. The AUC of the nomogram was 0.834 (95% CI, 0.790-0.878) in the training cohort, 0.806 (95% CI, 0.791-0.880) in the internal validation cohort, and 0.882 (95% CI, 0.810-0.954) in the external validation cohort, which indicated that the model had good discrimination. The calibration and DCA curves showed that the nomogram had good accuracy and clinical utility. CONCLUSIONS: In this study, we established a nomogram that can be used to identify the risk of aspiration associated with dysphagia after stroke, and patients may benefit from early screening and preventive care.

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INTRODUCTION: The association between the use of cilostazol as a post-stroke antiplatelet medication and a reduction in post-stroke pneumonia has been suggested. However, whether cilostazol has a greater preventive effect against post-stroke aspiration pneumonia (AP) than other antiplatelet medications remains unclear. Thus, this study aimed to evaluate whether cilostazol has a greater preventive effect against post-stroke AP than aspirin or clopidogrel. METHODS: Through the Japanese Diagnosis Procedure Combination database, we identified patients who were hospitalized for ischemic stroke between April 2012 and September 2019. We performed 1:1 propensity score matching between patients who received cilostazol alone at discharge and those who received aspirin or clopidogrel alone at discharge. The primary outcome was the 90-day readmission for post-stroke AP. The occurrence of recurrent ischemic stroke within 90 days was also evaluated. RESULTS: Among the 305,543 eligible patients with ischemic stroke, 65,141 (21%), 104,157 (34%), and 136,245 (45%) received cilostazol, aspirin, and clopidogrel, respectively. Propensity score matching generated 65,125 pairs. The cilostazol group had a higher proportion of 90-day post-stroke readmissions with AP than the aspirin or clopidogrel groups (1.5% vs. 1.2%, p < 0.001). The proportion of patients with recurrent ischemic stroke within 90 days was also higher in the cilostazol group (2.4% vs. 2.2%, p = 0.017). CONCLUSION: The present study suggests that cilostazol may not have a greater effect on preventing post-stroke AP within 90 days than other antiplatelet medications. Nevertheless, further randomized controlled trials with longer follow-up periods are warranted.

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OBJECTIVE: This study aimed to present experience with surgical treatment of laryngeal cleft cases through both open and endoscopic approaches. METHOD: A retrospective evaluation of all patients diagnosed as having a laryngeal cleft in a tertiary hospital over 10 years was performed. Pre-operative data, conservative and surgical management of cases, and outcomes were collected, tabulated and analysed. RESULTS: This study included 43 patients aged from 2 to 44 months with a median of 9.19 months. Concerning management technique, 12 patients had conservative treatment and the remaining 31 underwent a surgical procedure (of them, 20 patients underwent endoscopic intervention and 11 had the open surgical technique). In the open group, we used either tibial periosteum (six cases) or harvested costal cartilage (five cases). CONCLUSION: Surgical management in the form of endoscopic Coblation-assisted or an open approach is indicated in severe cases or mild cases not responding to conservative management.

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Abstract Background The early identification of risk for dysphagia in patients with Parkinson's disease (PD) is essential for the prevention of nutritional and pulmonary complications. Objective To analyze the sensitivity and specificity of the Swallowing Disturbance Questionnaire (SDQ-PD) and the Eating Assessment Tool (EAT-10) in identifying dysphagia risk in patients with early and intermediate stages of PD. Methods Twenty-nine patients with PD participated in the study. EAT-10 and SDQ-PD questionnaires were applied, and a videofluoroscopic swallowing study. Dysphagia Outcome and Severity Scale (DOSS) was used to classify the presence and severity of dysphagia, and the Penetration-Aspiration Scale (PAS) was used to identify the presence of penetration/aspiration. In the statistical analysis, the sensitivity and specificity of the risk questionnaires were calculated, as well as positive predictive value, negative predictive value, and accuracy. Results EAT-10 to identify the risk of penetration/aspiration revealed a sensitivity of 71.42% and specificity of 45.45%; in the identification of the presence of dysphagia, the sensitivity was 47.61%, and the specificity was 12.5%. The SDQ-PD questionnaire for risk of penetration/aspiration demonstrated a sensitivity of 28.57%, and a specificity of 68.18%. In terms of identifying the presence of dysphagia, the sensitivity was 20%, while the specificity was 44.44%. Conclusion The SDQ-PD revealed low sensitivity and low specificity to identify the presence of dysphagia and/or penetration/aspiration in patients with early and intermediate stages of PD in this sample. Despite its low specificity, the EAT-10 exhibited good sensitivity in indicating the risk of penetration/aspiration.

Resumo Antecedentes A identificação precoce de risco para disfagia nos pacientes com doença de Parkinson (DP) é fundamental para a prevenção de complicações nutricionais e pulmonares. Objetivo Analisar a sensibilidade e especificidade dos questionários Swallowing Disturbance Questionnaire (SDQ-PD) e Eating Assessment Tool (EAT-10) para a identificação do risco de disfagia em pacientes com DP nos estágios iniciais e intermediários da doença. Métodos Participaram 29 pacientes com DP. Foi realizado a aplicação dos questionários EAT-10 e SDQ-PD e o exame de videofluoroscopia da deglutição. Para a classificação da presença e gravidade da disfagia foi utilizada a escala Dysphagia Outcome and Severity Scale e, para identificação da presença de penetração/aspiração, a escala Penetration-Aspiration Scale (PAS). Na análise estatística, calcularam-se a sensibilidade e a especificidade dos questionários de risco EAT-10 e SDQ-DP e o valor preditivo positivo, o valor preditivo negativo e a acurácia. Resultados A análise do EAT-10 para identificar o risco de penetração/aspiração revelou sensibilidade de 71.42% e especificidade de 45.45%; para identificar a presença de disfagia, a sensibilidade foi de 47,61% e a especificidade de 12.5%. Em relação ao questionário SDQ-PD, para identificar risco de penetração/aspiração, a sensibilidade foi de 28.57% e a especificidade de 68.18% e, para identificar a presença de disfagia, a sensibilidade foi de 20% e a especificidade de 44.44%. Conclusão O questionário SDQ-PD revelou baixa sensibilidade e baixa especificidade para identificar presença de disfagia e/ou penetração/aspiração em pacientes com DP em estágios iniciais e intermediários para essa amostra. O EAT-10 revelou boa sensibilidade na indicação de risco de penetração/aspiração, apesar de baixa especificidade.

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BACKGROUND: The risk of aspiration is high in stroke patients due to dysphagia/loss of swallowing. This problem can cause problems affecting the nutrition of patients. Due to the possible risk of aspiration during feeding, patient relatives are hesitant to feed their patients. Because of this fear, malnutrition and hospital readmissions may increase. It is important to evaluate the fear of aspiration risk of relatives of patients hospitalized in the neurology service. The aim of this study is to determine the views of the relatives of patients treated in the neurology service about the risk of aspiration through metaphors. METHOD: This article analyzed metaphors of patients' relatives' about the risk of aspiration. The analysis uses metaphor identification and analysis. The research sample consisted of 31 patients. First of all, in the study, evaluation of the data was conducted by performing content analysis, as a result of which it was divided into metaphors and conceptual categories, and the relevant field was associated with the text (event, thought, feelings, related in speech or writing). In the reporting of research, the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. RESULTS: It was seen that the patients' relatives produced 31 different metaphors in response to the statement 'Aspiration risk is like …, because it is …' The patients' relatives mostly compared the concept of 'fear of aspiration' to the concept of 'fear' (n: 24). CONCLUSIONS: In this study, relatives mostly described the concept of fear related to the risk of aspiration. According to this result, patients' relatives have a great fear of aspiration increasing the risk of readmission to hospital and of malnutrition. This result shows that informing patients' relatives will increase awareness and will allow them to provide informed care. PATIENT AND PUBLIC CONTRIBUTION: Collaborated with patients and their relatives regarding the risk of aspiration and contributed to the planning of care for the risk of aspiration.

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Absent epiglottis is a rare reported anomaly in adults with unknown incidence. Most patients with absent epiglottis have presented with life-threatening symptoms of respiratory distress or severe aspiration in infancy or early childhood. We report a case of a 35 year old male patient with complete absence of epiglottis, presented with complaint of hoarseness of voice since birth.

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RESUMEN Objetivos. Determinar la asociación entre el tiempo de enfermedad previo a broncoscopia y el tiempo de alta posbroncoscopia en pacientes pediátricos con aspiración de cuerpo extraño. Materiales y métodos. Estudio de cohorte retrospectivo. El estudio y la revisión de historias clínicas se realizó en el Hospital de Emergencias Pediátricas de Lima, Perú. Se revisaron 324 historias clínicas, de las cuales, 183 historias fueron seleccionadas por contar con diagnóstico de cuerpo extraño en vías aéreas y estar adecuadamente llenadas. Para el análisis bivariado se utilizó la prueba exacta de Fisher y U de Mann Whitney, mientras que para el cálculo del riesgo relativo (RR) y su respectivo intervalo de confianza (IC) al 95% se utilizó regresión de Poisson. Resultados. Se incluyeron 183 pacientes, de los cuales, el 65,6% fueron hombres con una media de 2,4 años. La localización más frecuente fue el árbol bronquial derecho y cuerpo extraño de material orgánico. La mayoría (72,7%) de pacientes tuvieron un alta temprana antes de las 24 horas. Se encontró una asociación entre el tiempo de enfermedad previo a la broncoscopia y el tiempo alta posbroncoscopia (RR: 2,94, IC 95%: 1,72-5,01). Conclusiones. Existe una asociación estadísticamente significativa entre el tiempo de enfermedad previo a la broncoscopia y el tiempo de estancia hospitalaria posextracción del cuerpo extraño al ajustar por edad, sexo tipo de cuerpo extraño y maniobra de boca como medida de rescate. Este hallazgo es relevante debido a que pone en evidencia la importancia de una atención temprana, diagnóstico oportuno y manejo precoz en el paciente pediátrico.

ABSTRACT Objective. To determine the association between pre-bronchoscopy time of illness and post-bronchoscopy discharge time in pediatric patients with foreign body aspiration. Materials and methods. Retrospective cohort study. Medical records were studied and reviewed at the Pediatric Emergency Hospital of Lima, Peru. We reviewed 324 medical records, and selected 183 because they had the diagnosis of foreign body aspiration and complete data. Fisher's exact test and Mann Whitney U test were used for the bivariate analysis, while Poisson regression was used to calculate the Relative Risk (RR) and its 95% confidence interval (CI). Results. We included 183 patients, of whom 65.6% were men with a mean age of 2.4 years. The most frequent location of the foreign body was the right bronchial tree and most of them were made of organic material. The majority (72.7%) of patients were discharged before 24 hours. We found an association between the time of illness prior to bronchoscopy and post-bronchoscopy discharge time (RR: 2.94, 95%CI: 1.72 - 5.01). Conclusions. The time of illness prior to bronchoscopy and the length of hospital stay after removal of the foreign body were significantly associated when adjusted for age, sex, type of foreign body and mouth sweep maneuver as a rescue measure. Our findings are relevant because they highlight the importance of early care, timely diagnosis and early management of pediatric patients.

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This article presents the first reported case series of three cases of aspiration of a dental implant screwdriver, which was successfully removed by flexible bronchoscopy. The report highlights preventive measures that can be taken in the dental office and the clinical signs and symptoms of the presence of a dental implant screwdriver in the bronchial tree. The nine reports published to date on this phenomenon are reviewed and compared, and an action protocol for dental practitioners, anaesthetists and pulmonologists is proposed to address this emergency. Some early and late complications are also described.

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Abstract Aspiration of gastric contents during induction of general anesthesia remains a significant cause of mortality and morbidity in anesthesia. Recent data show that pulmonary aspiration still accounts for many cases with implications on mortality despite technical and technological evolution. Practical, ethical, and methodological issues prevent high-quality research in the setting of aspiration and rapid sequence induction/intubation, and significant controversy is ongoing. Patients' position, drugs choice, dosing and timing, use of cricoid force, and a reliable risk assessment are widely debated with significant questions still unanswered. We focus our discussion on three approaches to promote a better understanding of rapid sequence induction/intubation and airway management decision-making. Firstly, we review how we can use qualitative and quantitative assessment of fasting status and gastric content with the point-of-care ultrasound as an integral part of preoperative evaluation and planning. Secondly, we propose using imaging-based mathematical models to study different patient positions and aspiration mechanisms, including identifying aspiration triggers. Thirdly, we promote the development of a global data collection system aiming to obtain precise epidemiological data. Therefore, we fill the gap between evidence-based medicine and experts' opinion through easily accessible and diffused computer-based databases. A better understanding of aspiration epidemiology obtained through focused global data gathering systems, the widespread use of ultrasound-based prandial status evaluation, and development of advanced mathematical models might potentially guide safer airway management decision making in the 21st century.

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BACKGROUND: Patients arriving at the emergency department with a potential cervical spine injury and immobilized in a rigid cervical collar often require emergency airway management and rapid sequence induction intubation (RSII). There have been several advances in airway management with the advent of channeled (AirtraqⓇ; Prodol Meditec) and nonchanneled (McGrathⓇ; Meditronics) video laryngoscopes, which enable intubation without the removal of the cervical collar, but their efficacy and superiority over conventional laryngoscopy (Macintosh) in the presence of a rigid cervical collar and cricoid pressure have not been evaluated. OBJECTIVE: Our aim was to compare the channeled (Airtraq [group A]) and nonchanneled (McGrath [Group M]) video laryngoscopes with a conventional laryngoscope (Macintosh [Group C]) in a simulated trauma airway. METHODS: A prospective randomized controlled study was conducted in a tertiary care center. Participants were 300 patients requiring general anesthesia (American Society of Anesthesiologists class I or II), of both sexes, and aged 18-60 years. Airway management was simulated without removal of a rigid cervical collar and using cricoid pressure during intubation. After RSI, patients were intubated with one of the study techniques according to randomization. Intubation time and intubation difficulty scale (IDS) score were noted. RESULTS: Mean intubation time was 42.2 s in group C, 35.7 s in group M, and 21.8 s in group A (p = 0.001). Intubation was easy in group M and group A (median IDS score of 0; interquartile range [IQR] 0-1 for group M and median IDS score of 1; IQR 0-2 for group A and group C; p < 0.001). A higher proportion (95.1%) of patients had an IDS score of < 1 in group A. CONCLUSIONS: The performance of RSII with cricoid pressure in the presence of a cervical collar was easier and more rapid with channeled video laryngoscope than with other techniques.

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