Endotracheal intubation using a spiral endotracheal tube effectively reduces total tube handling time in children aged one month to six years using a McGrath™ video laryngoscope: a prospective randomized trial

Background: Airway management in children is challenging because of the smaller size, different proportions of anatomical structures compared to adults, and a higher risk of hypox-emia. Efforts to improve the efficiency of pediatric intubation can be made by manually twisting a spiral endotracheal tube (ETT) using a flexible stylet to manipulate its shape and angle. Methods: This controlled trial randomized fifty children aged one month to six years who un-derwent elective surgery under general anesthesia into two groups (spiral ETT [sETT] and no-stylet ETT/standard ETT). The sETT was formed by twisting the ETT using a handmade tool. The primary objective was to determine the effectiveness of the sETT compared to the standard ETT in reducing intubation time. Secondary objectives were ETT placement accura-cy, first-attempt intubation success rate, and adverse effects. Results: The mean total tube handling time in the sETT group was significantly shorter compared to the no-stylet ETT group (sETT 16.8 ± 3.6 vs. standard ETT 18.8 ± 3.7 seconds; P = 0.049). sETT placement had a significantly greater central placement accuracy (odds ratio, 4.846; 95% confidence interval, 1.287-18.255; P = 0.015). However, first-attempt successful intubation rate (sETT 80% vs. standard ETT 64%, P = 0.208) and total intubation time (sETT: 46.5 ± 5.2 vs. standard ETT 48.4 ± 4.9 seconds; P = 0.205) were not significantly different. No adverse effects were observed for either ETT type. Conclusions: Spiral ETT effectively reduces total tube handling time and improves ETT placement accuracy in children using video laryngoscopy.