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Every emergency physician has a preferred “bend angle” for the stylet and endotracheal tube (ETT) used for intubation. The authors of this study evaluated the effect of the bend angle on intubation success.
Thirty-two operators (27 attending physicians, 3 residents, and 2 paramedics) performed direct laryngoscopy and intubation on each of eight nonformalin-fixed human cadavers using randomly ordered straight-to-cuff styletted tubes bent at four different angles: 25 degrees, 35 degrees, 45 degrees, and 60 degrees. Operators subjectively rated ease of tube passage during each intubation attempt as no resistance, some resistance, or impossible to advance. Of 256 intubation attempts for each angle, tube passage was impossible for 2.3% of attempts with the tube bent at 25 degrees, 3.5% at 35 degrees, 11.3% at 45 degrees, and 53.9% at 60 degrees.
Levitan RM et al. Stylet bend angles and tracheal tube passage using a straight-to-cuff shape. Acad Emerg Med 2006 Dec; 13:1255-8.
Comment
Traditional teaching dictates a subtle angle for the “hockey stick” bend in the ETT to facilitate passage through the cords. After the ETT passes through the glottic opening, an excessively acute angle can cause the tube to bump against the anterior trachea, making further passage of the tube difficult. This study reinforces the idea that using a less severe angle can increase the likelihood of successful intubation.