Point | Counterpoint – DL Is Not the Building Block for Learning VL

August 13, 2024

Written by Aaron Lacy

Spoon Feed
Yesterday we looked at an argument for learning DL prior to VL. Today, we are covering the counterpoint, where this group argues that DL is not the building block for learning VL.

I can see clearly now, the view is here…
These authors wrote a counterpoint to yesterday’s article, which argued that teaching DL is the building block for VL.

Here are the key points:

• Novice intubators (or those with infrequent intubation experience) perform much better with VL than DL; therefore, the focus should be on VL implementation and teaching.
  • It’s estimated that even those with 100+ intubation attempts still had better success with VL.
• VL is better for difficult airways.
• The cost of VL is justified and is becoming more economical.
  • Even if the initial price of the VL devices seems high, it is reusable, and over time, the per-use cost is low.
• VL devices allow teaching of DL technique.

How will this change my practice?
I made my feelings clear yesterday on which Point | Counterpoint resonates the most with me. I think that VL is better for patients and better for teaching. I think that using VL to its maximum potential, including leveraging the recording feature for reviewing airways, is critical to teaching optimal airway technique. Again, we still need to know DL; however, I think that teaching for the standard of care and utilizing VL to make us better at DL when it is needed is the way forward.

Source
COUNTERPOINT: Direct Laryngoscopy: The Building Block to Airway Expertise? No. Chest. 2024 Jun;165(6):1297-1299. doi: 10.1016/j.chest.2024.01.027. PMID: 38852967

Another Spoonful
The authors of the article covered yesterday did publish an additional reply to this article, which can be found HERE.