Authors: Leo et al.
BMC Anesthesiology, published March 18, 2026
Key Points
Difficult tracheal intubation remains a major concern in airway management, even with video laryngoscopy.
This randomized clinical trial studied patients with anticipated difficult airways, defined by a high Arné score.
The ProVu Video Stylet was tested in combination with either direct laryngoscopy or video laryngoscopy.
First-pass intubation success was higher in both ProVu-assisted groups compared with video laryngoscopy alone.
Intubation time was shorter with ProVu-assisted techniques, and no severe complications or oxygen desaturation below 90% occurred.
Summary
This randomized clinical trial evaluated whether the ProVu Video Stylet could improve intubation outcomes in anesthetized patients with anticipated difficult airways. Difficult tracheal intubation remains an important anesthesia safety issue. Although video laryngoscopy has improved glottic visualization and is widely used for difficult airway management, intubation can still be challenging, especially when passage of the endotracheal tube does not match the improved view.
The study included 114 adult patients undergoing elective surgery who were considered at higher risk for difficult intubation based on an Arné score of 11 or greater. Patients were randomized into 3 groups: video laryngoscopy using the C-MAC D-Blade alone, ProVu Video Stylet with direct laryngoscopy, or ProVu Video Stylet with video laryngoscopy.
The primary outcome was first-pass intubation success. Secondary outcomes included laryngoscopy time, intubation time, number of attempts, need for external airway manipulation, and complications related to difficult intubation.
The main finding was that first-pass intubation success was significantly higher in both ProVu-assisted groups compared with video laryngoscopy alone. First-pass success was 100% in the ProVu-assisted groups compared with 86.8% in the video laryngoscopy-only group. This suggests that adding a video stylet may help convert a good laryngoscopic view into successful tube placement.
Intubation times were also shorter in the ProVu groups. Median intubation time was approximately 32 seconds with ProVu-assisted direct or video laryngoscopy, compared with approximately 39 seconds in the video laryngoscopy-only group. While the absolute time difference was modest, shorter intubation time can be clinically meaningful in patients at risk of difficult airway management or rapid desaturation.
Importantly, no episodes of oxygen desaturation below 90%, need for rescue airway techniques, or severe complications were reported. Minor complications occurred mainly in the video laryngoscopy-alone group.
The authors concluded that integrating the ProVu Video Stylet with either direct laryngoscopy or video laryngoscopy improved first-attempt intubation success and reduced intubation time compared with video laryngoscopy alone in patients with anticipated difficult airways.
What You Should Know
This study supports the idea that difficult airway management is not only about seeing the vocal cords. Video laryngoscopy can improve the view, but passing the endotracheal tube can still be difficult. A video stylet may help guide the tube more precisely into the trachea.
For anesthesia providers, the practical message is that ProVu-assisted intubation may be useful in patients with anticipated difficult airways, especially when anatomy or airway assessment suggests that tube delivery could be challenging. The device appeared effective when paired with either direct laryngoscopy or video laryngoscopy.
The study was relatively small and open-label, so larger studies would be helpful. However, the results are encouraging and suggest that video stylet-assisted techniques may improve first-pass success while maintaining a favorable safety profile.
Overall, the article highlights a useful airway strategy: combining visualization tools may improve intubation success more than relying on video laryngoscopy alone.
Thank you to BMC Anesthesiology for allowing us to summarize and share this article.