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Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults.

Janz DR, Semler MW, Lentz RJ, Matthews DT, Assad TR, Norman BC, Keriwala RD, Ferrell BA, Noto MJ, Shaver CM, Richmond BW, Zinggeler Berg J, Rice TW, Facilitating EndotracheaL intubation by Laryngoscopy technique and apneic Oxygenation Within the ICU Investigators and the Pragmatic Critical Care Research Group
Crit Care Med. 2016 44 (11): 1980-1987

PMID: 27355526 · PMCID: PMC5203695 · DOI:10.1097/CCM.0000000000001841

OBJECTIVE - To evaluate the effect of video laryngoscopy on the rate of endotracheal intubation on first laryngoscopy attempt among critically ill adults.

DESIGN - A randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows.

SETTING - Medical ICU in a tertiary, academic medical center.

PATIENTS - Critically ill patients 18 years old or older.

INTERVENTIONS - Patients were randomized 1:1 to video or direct laryngoscopy for the first attempt at endotracheal intubation.

MEASUREMENTS AND MAIN RESULTS - Patients assigned to video (n = 74) and direct (n = 76) laryngoscopy were similar at baseline. Despite better glottic visualization with video laryngoscopy, there was no difference in the primary outcome of intubation on the first laryngoscopy attempt (video 68.9% vs direct 65.8%; p = 0.68) in unadjusted analyses or after adjustment for the operator's previous experience with the assigned device (odds ratio for video laryngoscopy on intubation on first attempt 2.02; 95% CI, 0.82-5.02, p = 0.12). Secondary outcomes of time to intubation, lowest arterial oxygen saturation, complications, and in-hospital mortality were not different between video and direct laryngoscopy.

CONCLUSIONS - In critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications.

MeSH Terms (18)

Academic Medical Centers Aged Carbon Dioxide Critical Illness Female Hospital Mortality Humans Intensive Care Units Intubation, Intratracheal Laryngoscopy Length of Stay Male Middle Aged Oxygen Prospective Studies Respiration, Artificial Time Factors Video Recording

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