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Original article
Available online 10 June 2026

Exploring the potential role of augmented-reality smart glasses in the management of the difficult airway. The SMART-INTUBATION study

Explorando el papel potencial de las smart glasses de realidad aumentada en el manejo de la vía aérea difícil. El estudio SMART-INTUBATION
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Emilio Rodriguez-Ruiza,b,c,
Corresponding author
emilio.rodriguez@usc.es

Corresponding author.
, Silvia Aranda-Garcíac,d, Rita García-Fernándezb,e, Carmen Elisa Espinosa-Pereirob,e, Maitane Campelo-Izquierdof, Jorge Fernández-Rodríguezg, Gloria Prada-Hervellag, Ana Estany-Gestalh, Miguel A. Rodríguez-Vargasi,j, Antonio Rodríguez-Núñezb,c,d
a Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
b Simulation, Life Support & Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
c CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
d GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona (UB), Barcelona, Spain
e Paediatric Intensive, Intermediate and Palliative Care Unit, Department of Pediatrics, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
f Division of Nursing, Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
g Anesthesiology Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
h Epidemiology and Clinical Research Unit, Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
i School of Medicine, University of Santiago de Compostela, Spain
j Integral Clinical Simulation Centre of the Santiago Health Area (CESIS), Spain
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Abstract
Objective

To evaluate the potential role of augmented-reality smart glasses (A-SGs) for the assistance of residents in airway management.

Design

Observer-blinded, parallel-group, randomised trial.

Setting

An integrated clinical simulation centre.

Participants

Residents involved in critically ill patient care.

Interventions

Each participant performed a baseline endotracheal intubation (ETI) trial and a follow-up ETI trial (M1). Before M1 participants were randomly assigned either to the control group (unguided) or to the intervention group (tele-guided with A-SGs). No support was provided to participants during the M0 or during M1 in the control group. Residents allocated to A-SGs received real-time audio and video guidance from an expert in airway management.

Main variables

Sociodemographic variables, the execution of each ETI step, the ETI efficacy ETI, and all procedural times.

Results

The 39 residents obtained comparable results at M0. During M1, participants tele-guided with A-SGs performed the ETI in a more organised and structured way, especially when inserting the endotracheal tube (p = 0.003) and checking its proper placement (p < 0.001). Higher ETI efficacy was observed in the intervention group compared with the control (p < 0.001). Within the intervention group itself, significant improvement in intubation efficacy was observed between M0 and M1 (p < 0.001).

Conclusions

A-SGs tele-assistance while the trainee shares the airway view with a remote expert is feasible and may have a positive impact on training residents on difficult airway management.

Keywords:
Airway management
Endotracheal intubation
Smart glasses
Augmented reality
Simulation training
Medical training
Patient safety
Quality of care
Resumen
Objetivo

Evaluar el papel potencial de las smart glasses de realidad aumentada (A-SGs) para la teleasistencia en el manejo de la vía aérea.

Diseño

Estudio aleatorizado, ciego a terceros, con grupos paralelos.

Ámbito

Centro de simulación clínica integrada.

Participantes

Residentes implicados en la atención de pacientes críticos.

Intervenciones

Cada participante realizó una intubación endotraqueal (ETI) basal (M0) y una ETI de seguimiento (M1). Antes de M1, los participantes fueron asignados aleatoriamente al grupo control (sin guía) o al grupo de intervención (tele-guiado con A-SGs). No se proporcionó apoyo a los participantes durante M0 ni durante M1 en el grupo control. Los residentes asignados al grupo A-SGs recibieron guía en tiempo real, tanto por audio como por vídeo, por parte de un experto en manejo de la vía aérea.

Variables principales de interés

Variables sociodemográficas, ejecución de cada paso de la ETI, eficacia de la ETI y los tiempos del procedimiento.

Resultados

Los 39 residentes obtuvieron resultados similares en M0. Durante M1, los participantes tele-guiados con A-SGs realizaron la ETI de forma más organizada y estructurada, especialmente la inserción del tubo endotraqueal (p = 0,003) y la comprobación de su correcto posicionamiento (p < 0,001). Se observó una mayor eficacia de la ETI en el grupo de intervención en comparación con el grupo control (p < 0,001). Dentro del propio grupo de intervención, se observó una mejora significativa en la eficacia de la ETI entre M0 y M1 (p < 0,001).

Conclusiones

La teleasistencia con A-SGs, mientras que el residente comparte la visión de la vía aérea con un experto remoto, es factible y puede tener un impacto positivo en su formación en el manejo de la vía aérea difícil.

Palabras clave:
Manejo de la vía aérea
Intubación endotraqueal
Smart glasses
Realidad aumentada
Simulación
Formación médica
Seguridad del paciente
Calidad asistencial

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