Abstract: End-expiratory carbon dioxide concentrations can be used to assist endotracheal intubation. The novel multimodal endotracheal intubation guidance device combined visualization with an end-expiratory carbon dioxide concentration vectorization algorithm to achieve more accurate placement in difficult airways. The feasibility of a novel multimodal guidance device for the endotracheal intubation of difficult airways was verified in spontaneously breathing Bama miniature pigs. The glottic exposure time, insertion time, and total intubation time were not significantly different between the fiberoptic bronchoscope group and the multimodal guidance device group in regard to the endotracheal intubation of difficult airways. There were also no significant differences in intubation attempts, first success rate, and total success rate. Animals in both groups experienced hypoxemia, hypotension,and esophageal intubation during endotracheal intubation, but there were also no significant differences in the incidence of adverse events between the two devices. The effect on changes in hemodynamics, heart rate, and oxygen saturation during intubation showed no significant difference between the two devices. The results of the present study demonstrated the feasibility and effectiveness of the initial prototype of a multimodal guidance device for the endotracheal intubation of difficult airways in pigs, which is expected to further assist in adequately positioning the airway during difficult endotracheal intubations with spontaneous breathing.

Key words: endotracheal intubation| autonomous respiratio| end-expiratory carbon dioxide|multimodal guidance device| airway management