Fingers Grip as good as Conventional Pen-Holding Grip for holding Endotracheal tube before Intubation - Study

Recent study compared the efficacy of the between-the-fingers grip with the conventional pen-holding grip to hold an endotracheal tube (ETT) for orotracheal intubation. A total of 300 patients undergoing elective surgeries under general anesthesia were randomized into two groups: Group C (conventional grip) and Group M (modified, between-the-fingers grip). A designated anaesthetist blinded to the groups performed laryngoscopy, and upon revealing the group, intubation was done accordingly. It was found that single-attempt intubation was comparable between the groups, but the usage of external assistance as BURP and the time taken for intubation were significantly reduced in the modified grip group. The study concluded that the between-the-fingers grip seems as effective as the standard grip to hold the ETT during intubation while reducing the requirement for external assistance in BURP.

Primary and Secondary Objectives of the Study

The primary objective of the study was to compare the number of attempts required for orotracheal intubation and the comparison of the requirement of external assistance in the form of the backward upward rightward pressure maneuver (BURP) to perform endotracheal intubation (ETI). The secondary objectives were to compare the time taken for ETI for each grip and the haemodynamic parameters (heart rate (HR) and mean arterial pressure (MAP)) in the two groups. The study was conducted on patients aged between 18 and 60 years posted for elective surgeries under general anesthesia with ETT. A total of 276 patients completed the study, and in the final analysis, 143 patients in Group C and 133 in Group M were included. The demographic distribution of the study patients, including airway variables, was comparable between the two study groups. The number of patients with a single attempt for intubation was 97.2% versus 99.3% in Group C and Group M, respectively. The requirement of assistance, in the form of BURP, was significantly lower in the modified grip group (0.75% versus 6.99%). Time taken for tracheal intubation was also less in the modified grip group than in the conventional group. The haemodynamic parameters, including HR and MAP, were statistically comparable in both groups.

Conclusion and Limitations

The study concluded that the between-the-finger grip proved to be an equally good method to hold the endotracheal tube for orotracheal intubation as compared to the standard method. The findings suggest that this modified grip can reduce the requirement for external assistance in BURP and decrease the time necessary to accomplish the ETI. However, the study had some limitations, such as being a single-center trial and a lack of available literature to guide the sample size calculation. Nevertheless, the modified grip's efficacy was demonstrated, and the study suggests its potential as an alternative to the conventional pen-holding grip for ETT placement during orotracheal intubation.

Key Points

1. The primary objective of the study was to compare the number of attempts required for orotracheal intubation and the comparison of the requirement of external assistance in the form of the BURP maneuver to perform endotracheal intubation. The secondary objectives were to compare the time taken for intubation for each grip and the haemodynamic parameters (heart rate and mean arterial pressure) in the two groups. The study found that the modified grip group had a significantly lower requirement for assistance in the form of BURP and a reduced time for tracheal intubation compared to the conventional group. The haemodynamic parameters were statistically comparable in both groups, and the demographic distribution of the study patients was also comparable between the two study groups.

2. The study concluded that the between-the-finger grip proved to be an equally effective method to hold the endotracheal tube for orotracheal intubation compared to the standard method. The findings suggest that this modified grip can reduce the requirement for external assistance in BURP and decrease the time necessary to accomplish the intubation. However, the study had some limitations, such as being a single-center trial and a lack of available literature to guide the sample size calculation. Nevertheless, the modified grip's efficacy was demonstrated, and the study suggests its potential as an alternative to the conventional pen-holding grip for ETT placement during orotracheal intubation.

Reference –

Thakur S, Tewari P, Shamshery C, Mishra P. To compare the efficacy of the between the fingers grip with the conventional pen holding grip to hold an endotracheal tube for orotracheal intubation: A randomised controlled trial. Indian J Anaesth 2024;68:527-32.