Video versus direct laryngoscopy on successful first-pass endotracheal intubation in ICU patients

doi:10.5847/wjem.j.1920-8642.2018.02.003

Abstract

Abstract:

BACKGROUND: Airway management in intensive care unit (ICU) patients is challenging. The aim of this study was to compare the rate of successful first-pass intubation in the ICU by using the direct laryngoscopy (DL) and that by using the video laryngoscopy (VL).
METHODS: A randomized, non-blinded trial comparing first-pass success rate of intubation between VL and DL was performed. Patients were recruited in the period from August 2014 to August 2016. All physicians working at ICU received hands-on training in the use of the video and direct laryngoscope. The primary outcome measure was the first-pass intubation success.
RESULTS: A total of 163 ICU patients underwent intubation during the study period (81 patients in VL group and 82 in DL group). The rate of successful first-pass intubation was not significantly different between the VL and the DL group (67.9% vs. 69.5%, P=0.824). Moreover, the overall intubation success and total number of attempts to achieve intubation success did not differ between the two groups. In patients with successful first-pass intubation, the median duration of the intubation procedure did not differ between the two groups. The Cormack-Lehane grades and the percentage of glottic opening score were similar, and no significant differences were found between the two groups. There were no statistical differences between the VL and the DL group in intubation complications (all P>0.05).
CONCLUSION: Among ICU patients requiring intubation, there was no significant difference in the rate of successful first-pass intubation between VL and DL.

Key words: Intubation, Video laryngoscopy, Direct laryngoscopy, Intensive care unit

Yong-xia Gao, Yan-bo Song, Ze-juan Gu, Jin-song Zhang, Xu-feng Chen, Hao Sun, Zhen Lu. Video versus direct laryngoscopy on successful first-pass endotracheal intubation in ICU patients[J]. World Journal of Emergency Medicine, 2018, 9(2): 99-104.

Figures/Tables 3

Table 1

Figure 1.

Table 2

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Characteristics	VL (n=81)	DL (n=82)	P value
Age, years, mean±SD	68.72±16.88	69.86±15.55	0.422
Male sex, n (%)	58 (71.6)	56 (68.3)	0.645
Estimated weight, n (%)
< 76 kg	36 (44.4)	41 (50.0)	0.477
76-100 kg	33 (40.7)	32 (39.0)	0.823
101-150 kg	10 (12.3)	8 (9.8)	0.598
>150 kg	2 (2.5)	1 (1.2)	0.991
Reason for intubation, n (%)
Acute respiratory failure	42 (51.9)	45 (54.9)	0.699
Acute circulation failure	13 (16.0)	15 (18.3)	0.704
Acute neurological failure	8 (9.9)	6 (7.3)	0.560
Trauma	12 (14.8)	9 (11.0)	0.464
Others	6 (7.4)	7 (8.5)	0.790

Characteristics	VL (n=81)	DL (n=82)	P value
First-pass success, n (%)	55 (67.9)	57 (69.5)	0.824
Overall success, n (%)	75 (92.6)	74 (90.2)	0.593
Number of intubation attempts, median (IQR)	1 (1-3)	1 (1-3)	0.886
Duration of intubation, minutes, median (IQR)	3.5 (2-5)	3 (2-4)	0.923
Difficult intubation, n (%)	7 (8.6)	8 (9.8)	0.806
Cormack-Lehane grade, n (%)
1	42 (51.9)	36 (43.9)	0.310
2	24 (29.6)	30 (36.6)
3	9 (11.1)	8 (9.8)
4	6 (7.4)	8 (9.8)
Percentage of glottic opening score, median (IQR)	82.5 (50-100)	85 (67.5-100)	0.535
Type of complication, n (%)
Death	1 (1.2)	0 (0.0)	0.995
Cardiac arrest	1 (1.2)	0 (0.0)	0.995
Hypotension	16 (19.8)	19 (23.2)	0.595
Hypoxemia	14 (17.3)	12 (14.6)	0.644
Severe hypoxemia	4 (4.9)	2 (2.4)	0.666
Esophageal intubation	3 (3.7)	6 (7.3)	0.505
Aspiration	4 (4.9)	4 (4.9)	0.730
Arrhythmia	2 (2.5)	3 (3.7)	0.989
Dental injury	1 (1.2)	2 (2.4)	0.991

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