i-view™ product improvements and published evidence

The first clinical evidence available regarding the i-view came in the form of a poster, entitled ‘i-view™ the future? Initial experience with a novel disposable videolaryngoscope’.¹ from King’s College Hospital, which reported on the use of i-view™ in 30 adult patients requiring tracheal intubation for surgery. First attempt success was 86.7% and there were no reports of hypoxia or traumatic complications. A sub-group of 12/30 patients had a BMI greater than or equal to 35kg/m2 of which 91.7% were successfully intubated on the first attempt. The authors also confirmed that i-view™ shares the benefits of other video-enhanced Macintosh video laryngoscopes:

• External laryngeal manipulation is facilitated as the view on screen can guide the anaesthetic assistant

• A bougie can still be used

• Axis alignment allows for easier tube placement at the cords and advancement into the trachea, compared to a hyper-angulated blade, because of the more traditional Macintosh geometry.

• The screen is very helpful for teaching airway management to novices

• The screen gives a full picture of the target area, excluding the teeth, lips and beard etc

In April 2020, the Journal of Clinical Monitoring and Computing published a randomised controlled study comparing i-view to another well-known video laryngoscope in super obese patients². Both devices allowed for safe and effective intubation in super-obese patients (BMI >50kg/m2) and the hemodynamic response to video laryngoscopy was similar between devices.

The most recent evidence is correspondence in the form of a letter to the editor of Minerva Anestesiologica, entitled, ‘Emergency tracheal intubation in COVID-19 patients with the i-view video laryngoscope’3 was published in December 2020. The authors retrospectively reported on the performance of the i-view™ on a series of twenty patients with COVID-19 requiring intubation. Data was recorded for duration of intubation (power on to first CO2 detection), number of intubation attempts, outcome, Freemantle score, use of airway adjuncts, whether cricoid force was applied, rescue technique in case of failure, lowest saturation and complications. In addition, a satisfaction score was included with a visual analogue scale (VAS) ranking from 1 (no satisfaction) to 4 (maximum satisfaction).

There were no failures, with 18/20 first pass success and 2/20 second pass success. Mean intubation time was <2 minutes in all cases. The Freemantle score was 17/20 with a full view and 3/20 with a partial view. The VAS satisfaction score was 4 (maximum satisfaction) for 18/20 cases and 3 for 2/20 cases. While the debate as to which is the best video laryngoscope has yet to be resolved, the authors of this letter concluded that, ‘the possibility of having a completely (including screen) disposable and readily available device makes i-view™ a potential candidate as optimal choice VL.’ While acknowledging that more data is required to draw any conclusions, ‘we may hope that a good beginning bodes well’.

In conclusion, initial clinical evidence for i-view™ is encouraging. Further evidence is awaited with great interest.

References
1. Mann J, Abell D, Sharafudeen S, Dasan J. 2017. i-view the future? Initial experience with a novel disposable videolaryngoscope. [Poster]. Kochi Advanced Airway Management Conference. July 2017
2. Gaszynski T. A randomized controlled study on the visual grading of the glottis and the hemodynamics response to laryngoscopy when using I-View and MacGrath Mac videolaryngoscopes in super obese patients. Journal of Clinical Monitoring and Computing 2020;
3. Corso R.M, Cortese G, Cataldo R, Di Giacinto I, Sgalambro F, Terzitta M, Aiello L, Maitan S, Sorbello M. Emergency tracheal intubation in COVID-19 patients with the I-view videolaryngoscope. Minerva anestesiologica 2020; 15265-9