Laryngoscopy and Tracheal Intubation: Does Use of a Video Laryngoscope Facilitate Both Steps of the Procedure? - 20/09/23
, Stacy A. Trent, MD, MSPH c, Arianna Lofrano, DO b, Derek W. Russell, MD d, e, Christopher R. Barnes, MD f, Joseph M. Brewer, DO g, Kevin C. Doerschug, MD h, John P. Gaillard, MD i, j, Sheetal Gandotra, MD d, Adit A. Ginde, MD, MPH k, Shekhar Ghamande, MD l, Kevin W. Gibbs, MD m, Christopher G. Hughes, MD, MSc n, David R. Janz, MD, MSc o, Akram Khan, MD p, Steven H. Mitchell, MD q, David B. Page, MD, MSPH d, Todd W. Rice, MD, MSc r, Wesley H. Self, MD, MPH s, Lane M. Smith, MD, PhD t, Susan B. Stempek, PA-C, MBA u, Derek J. Vonderhaar, MD v, Jason R. West, MD w, Micah R. Whitson, MD d, x, Jonathan D. Casey, MD, MSc r, Matthew W. Semler, MD, MSc r, Brian E. Driver, MD aAbstract |
Study objective |
To compare the effect of the use of a video laryngoscope versus a direct laryngoscope on each step of emergency intubation: laryngoscopy (step 1) and intubation of the trachea (step 2).
Methods |
In a secondary observational analysis of data from 2 multicenter, randomized trials that enrolled critically ill adults undergoing tracheal intubation but did not control for laryngoscope type (video laryngoscope vs direct laryngoscope), we fit mixed-effects logistic regression models examining the 1) the association between laryngoscope type (video laryngoscope vs direct laryngoscope) and the Cormack-Lehane grade of view and 2) the interaction between grade of view, laryngoscope type (video laryngoscope vs direct laryngoscope), and the incidence of successful intubation on the first attempt.
Results |
We analyzed 1,786 patients: 467 (26.2%) in the direct laryngoscope group and 1,319 (73.9%) in the video laryngoscope group. The use of a video laryngoscope was associated with an improved grade of view as compared with a direct laryngoscope (adjusted odds ratio for increasingly favorable grade of view 3.14, 95% confidence interval [CI] 2.47 to 3.99). Successful intubation on the first attempt occurred in 83.2% of patients in the video laryngoscope group and 72.2% of patients in the direct laryngoscope group (absolute difference 11.1%, 95% CI 6.5% to 15.6%). Video laryngoscope use modified the association between grade of view and successful intubation on the first attempt such that intubation on the first attempt was similar between video laryngoscope and direct laryngoscope at a grade 1 view and higher for video laryngoscope than direct laryngoscope at grade 2 to 4 views (P<.001 for interaction term).
Conclusions |
Among critically ill adults undergoing tracheal intubation, the use of a video laryngoscope was associated both with a better view of the vocal cords and with a higher probability of successfully intubating the trachea when the view of the vocal cords was incomplete in this observational analysis. However, a multicenter, randomized trial directly comparing the effect of a video laryngoscope with a direct laryngoscope on the grade of view, success, and complications is needed.
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| Please see page 426 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Gregory W. Hendey, MD. Specific detailed information about a possible conflict of interest for individual editors is available at editors. |
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| Author contributions: MEP, SAT, JDC, MWS, and BED conceived and designed the study. All authors collaborated in data acquisition. MEP, JDC, MWS, and BED analyzed the data. MEP and BED drafted the manuscript, and all authors contributed substantially to its revision. MEP takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). JDC (K23HL153584) and MWS (K23HL143053) were supported in part by grants from the National Institutes of Health. The rest of the authors have stated that no such relationships exist. |
Vol 82 - N° 4
P. 425-431 - octobre 2023 Retour au numéro
Article précédent
- Sedative Dose for Rapid Sequence Intubation and Postintubation Hypotension: Is There an Association?
- Brian E. Driver, Stacy A. Trent, Matthew E. Prekker, Robert F. Reardon, Calvin A. Brown
- Defining Successful Intubation on the First Attempt Using Both Laryngoscope and Endotracheal Tube Insertions: A Secondary Analysis of Clinical Trial Data
- Stacy A. Trent, Brian E. Driver, Matthew E. Prekker, Christopher R. Barnes, Joseph M. Brewer, Kevin C. Doerschug, John P. Gaillard, Kevin W. Gibbs, Shekhar Ghamande, Christopher G. Hughes, David R. Janz, Akram Khan, Steven H. Mitchell, David B. Page, Todd W. Rice, Derek W. Russell, Wesley H. Self, Lane M. Smith, Susan Stempek, Derek J. Vonderhaar, Jason R. West, Micah R. Whitson, Adit A. Ginde, Jonathan D. Casey, Matthew W. Semler
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