70 yo female >50 pyh current smoker with severe COPD not on home oxygen presented with an oxygen saturation of 70%. She was found to have multi-lobar pneumonia predominately in the right upper and middle lobes. Despite Bipap therapy her hypoxia worsened, and she required intubation. Inspection of her oropharynx prior to intubation revealed very prominent 1stincisors as well as canines that were eroded at the roots left worse than right. Multiple black, necrotic molars right worse than left with a putrid odor. Her oxygen saturation, despite being on 15L nasal cannula, hovered in the low 90s. In anticipation of a difficult airway the AIROD® was prepared by extended the rods and ensuring the rods were in the locked position. A Miller 4 blade was gently inserted past the teeth and into the oropharynx. A grade 2 view was obtained. This was immediately followed by gentle insertion of the AIROD® which was advanced just distal to the vocal cords. An 8.0 endotracheal tube was advanced down the AIROD® by the respiratory therapist while the AIROD® was held in position. As the endotracheal tube was advanced into the oropharynx, hand position was changed from holding the AIROD® to holding the tip of the endotracheal tube while the respiratory therapist held the distal end of the AIROD®. The endotracheal tube was then advanced past the vocal cords and into the trachea while the respiratory therapist removed the AIROD® with ease. No complications occurred. No trauma occurred to the oropharynx, vocal cords or trachea. The patient was successful ventilated and oxygen saturations improved to high 90s.
61 yo male with severe schizophrenia and acute delirium with a PaO2 of 61 mmHg despite Bipap 14/6 on 90% fio2 with a minute ventilation of 18 L/min from multi-lobar pneumonia. A Miller 4 blade was gently inserted past the teeth and into the oropharynx. A grade 1 view was obtained. The AIROD® was gently advanced 2 cm past the vocal cords followed by an assistant advancing a 7.5 endotracheal tube down the AIROD® until grasped, then the endotracheal tube was slid into the trachea while the assistant held the distal end of the AIROD®. The AIROD® was then removed intact with no evidence of airway trauma.
54 yo male with severe coronary artery disease on aspirin and Plavix with a history of a seizure disorder associated with alcohol withdrawal became unresponsive and a code blue was called. He was found to be apneic with oxygen saturation in the 50s. He was stimulated by the Hospitalist and woke up. He was transferred to the ICU where he became completely unresponsive again and stopped breathing. He was immediately ventilated with a bag-valve mask and oxygenation improved to 100%. He then bolted up out of bed and became very combative. Propofol was given and he was laid supine and ventilated with a bag-valve mask. Inspection of his oropharynx revealed a very large tongue, some missing and multiple sharp teeth with mouth opening of only 2 finger breadths. There was blood and emesis in his oropharynx that was suctioned. A Miller 4 blade was inserted into the oropharynx but only a grade 4 view could be obtained. The AIROD® was inserted into the oropharynx in the fully extended and locked position and the proximal tip was used to gently lift the epiglottis exposing the vocal cords and improving the view to a grade 2. AIROD® was advanced 2 cm past the vocal cords and an assistant advanced an 8.0 endotracheal tube down the AIROD® until it was grasped, and the endotracheal tube was advanced successfully past the vocal cords while the assistant held the distal end of the AIROD®. The AIROD® was removed intact without any oropharyngeal or vocal cord trauma.
A 48 yo male obese alcoholic smoker who was critically ill with an admission albumin of 0.9 and lactic acid of 9 with multi-organ system failure from an intra-abdominal abscess with septic shock on 15 mcg/min of epinephrine and 25 mcg/min of Levophed was obtunded and in acute respiratory failure. The AIROD® was pre-loaded with an 8.0 endotracheal tube onto the distal end of the AIROD® prior to providing sedation with Etomidate and bag-valve mask ventilation in anticipation of a difficult airway: full beard, mouth opening 2 cm, large tongue, collapse of the walls of the oropharynx as well as false cords. Using a Miller 4 blade a grade 2 view was obtained and the AIROD® was advanced 1 cm past the vocal cords followed by the endotracheal tube while an assistant held the distal end. There was no significant desaturation or trauma to the vocal cords or oropharynx. Pre-loading the AIROD® with the endotracheal tube improved the speed and autonomy of the intubation.
A 71 yo female 5’3 70 kg with CKD 3 from NSAIDs and h/o MI admitted with septic shock from acute colitis on 10 levophed despite 6L fluids with renal failure, hyperkalemia, profound metabolic acidosis with a lactate >15 and a VBG pH 6.87 required emergent intubation. She was combative from acute encephalopathy, Mallampati IV, mouth opening was 3 cm after removal of dentures and she had a large tongue. The AIROD® was pre-loaded with a 7.0 endotracheal tube on the distal end. The proximal end of the AIROD® was kept clean by placing into the endotracheal tube packaging with the 20-degree tip pointing to the right and lying flat on the mattress. The AIROD® was then tucked underneath the patient’s right shoulder at a 45-degree angle to the neck for quick access by the operator. The patient received a small dose of propofol and was immediately ventilated with a bag-valve mask. A MAC 3 blade was gently placed into the mouth and a grade 2 view was obtained. The pre-loaded AIROD® was grasped at the smallest proximal section with the operator’s hand in the supine position while the operator’s eyes were fixed on the vocal cords. The square AIROD® was then rotated one 90 degrees turn counterclockwise only by feel without looking at the AIROD®. The AIROD® was gently inserted into the mouth and advanced just pass the vocal cords 2 cm. The respiratory therapist held the distal end while the 7.0 endotracheal tube was advanced down the AIROD®. It only took 10 seconds to intubate from insertion of the MAC blade until removal of the AIROD® and inflation of the endotracheal tube.
83 yo male 5’6 85 kg non-smoker with prior DVT/PE on Eliquis, hemolytic anemia, CLL on rituximab and previous histoplasmosis s/p partial lung resection developed acute respiratory failure despite broad spectrum antibiotics and steroids. CT chest revealed diffuse ground glass opacities throughout his LUL, RML and RLL. He was started on bipap12/6 w/ fio2 60% but hypoxia worsened despite a minute ventilation of 26 L/min. He was transferred to the ICU and immediately intubated. The AIROD® was pre-loaded with an 8.0 endotracheal tube at the distal end and tucked under the patient’s right shoulder with the tip lying flat and pointing laterally protected in its packaging. The AIROD® lay at a 45-degree angle to the neck. He was given propofol and immediately ventilated with a bag-valve mask. A Miller 4 blade was gently inserted into the mouth with a grade 1 view followed by grasping the AIROD® with the operator’s hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was advanced into the trachea. The AIROD® was removed intact without any evidence of oropharyngeal trauma. The intubation took approximately 10 seconds. A diagnostic bronchoscopy was performed next and did not reveal any tracheobronchial trauma.