When I intubate, I don't just VL, I VL 2.0.

Videolaryngoscopy is no longer one technique. Hyperangulated blades and Mac-style video blades create different views, require different tube-delivery strategies, and fail in different ways during emergency airway management.

Videolaryngoscopy 2.0 Airway Approach

• Precise VL terminology: “VL” is too vague for modern airway practice; naming hyperangulated VL versus Mac-VL better describes the intubation you actually performed and improves how clinicians communicate about difficult airways.
• Blade geometry matters: The key distinction is blade shape, not the presence of a camera: hyperangulated blades run about 60 to 70 degrees, while Mac-VL keeps standard Macintosh geometry with a very different feel and workflow.
• Different device techniques: Hyperangulated VL generally needs a rigid stylet for tube delivery, whereas Mac-VL is better suited to bougie-assisted intubation and should not be approached with the same hand mechanics.
• Soiled airway advantage: Mac-VL can look past the tongue and still permits a direct view if blood or vomit obscures the screen, a practical rescue advantage we get into in the episode.
• Teaching and backup planning: Mac-VL is useful for teaching direct laryngoscopy while sharing the screen, but neither blade guarantees first-pass or rescue success, so a backup airway plan still has to be explicit.
• Research language problem: Pooling hyperangulated devices and Mac-VL under one “VL” label muddies airway research, because device geometry changes performance, complications, and what success rates really mean.

References:

1. Law JA, et al. Videolaryngoscopy 2.0. Canadian Journal of Anaesthesia/Journal Canadien D’Anesthesie. 2021;69(4):409-415. PMID: 34918199
2. Lacy A. Videolaryngoscopy 2.0. Journal Feed. Published December 16, 2021. Accessed December 7, 2022. https://journalfeed.org/article-a-day/2022/videolaryngoscopy-20/. doi: 10.1007/s12630-021-02162-4.