Design: Prospective multicentre observational study, 44 hospitals
Population: 5,302 videolaryngoscopic tracheal intubations with paired operator–observer scoring
Primary outcome: Relationship between glottic view (POGO) and ease of tube delivery; inter-rater reliability
Effect: Difficult or failed despite POGO >75%: 6.3%; easy despite POGO <25%: 24.5%; alpha 0.86

A prospective observational study across 44 hospitals, published in Anaesthesia on 2 October, analysed 5,302 videolaryngoscopic intubations, each scored independently by the operator and an observer on three domains: blade geometry, glottic view by percentage of glottic opening (POGO), and ease of tracheal tube delivery.

The three-domain record was reproducible (Krippendorff's alpha 0.86). But view and delivery were poorly linked. Even with an excellent view (POGO above 75%), 6.3% of first attempts were difficult or failed. With POGO of 25% or more, about 10% were difficult or failed. Conversely, a quarter of intubations with a poor view (POGO below 25%) were easy.

The Cormack–Lehane grade was built for direct laryngoscopy, where seeing the cords and passing the tube are closely linked. With a hyperangulated blade, the cords may be in full view while the tube cannot be steered to them. Recording only the view therefore misleads the next anaesthetist. The authors propose recording what was used, what was seen and what was done.

Document the blade type, the glottic view and how easy tube delivery was after every videolaryngoscopic intubation.
Do not reassure the next team with a good view alone; record any difficulty steering the tube.
With a hyperangulated blade, have a stylet shaped to the blade curve ready before starting.
Plan for difficulty even with a full view — about 1 in 16 such attempts were difficult or failed.
Accept a partial view if the tube passes easily; a perfect view is not the goal.

Why it matters

Airway alerts based on view alone can falsely reassure the next anaesthetist.

The statistics, in plain English

An alpha of 0.86 means two independent raters agreed very closely on the three-domain score. The 6.3% figure is 252 of 4,025 intubations, so even rare-seeming difficulty with a good view adds up across a busy department.