Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU

Abstract

IntroductionEndotracheal intubation in the ICU is a challenging procedure and is frequently associated with life-threatening complications. The aim of this study was to investigate the effect of the C-MAC® video laryngoscope on laryngeal view and intubation success compared with direct laryngoscopy.MethodsIn a single-center, prospective, comparative before-after study in an anesthetist-lead surgical ICU of a tertiary university hospital, predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a 2-year study period (first year, Macintosh laryngoscopy (ML); second year, C-MAC®).ResultsA total of 274 critically ill patients requiring endotracheal intubation were included; 113 intubations using ML and 117 intubations using the C-MAC® were assessed. In patients with at least one predictor for difficult intubation, the C-MAC® resulted in more successful intubations on first attempt compared with ML (34/43, 79% vs. 21/38, 55%; P = 0.03). The visualization of the glottis with ML using Cormack and Lehane (C&L) grading was more frequently rated as difficult (20%, C&L grade 3 and 4) compared with the C-MAC® (7%, C&L grade 3 and 4) (P < 0.0001).ConclusionUse of the C-MAC® video laryngoscope improved laryngeal imaging and improved the intubating success rate on the first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potentially difficult endotracheal intubations regularly occur.

Cardiovascular response and backward, upward, right push maneuver during laryngoscopy: comparison between CMAC^® video laryngoscopy and conventional Macintosh

“…Cormack-Lehane grade 1 or 2 can be achieved by slightly lifting larynx up, which is in accordance with Noppens' study 17 that stated CMAC ® showed better laryngeal visualization; therefore, pain stimulus and catecholamine release were decreased. 17 CMAC ® has wider visualization than Macintosh (60° vs 15°), 18 aid to achieve better visualization of larynx and minimize pain stimulus, time for intubation, and BURP maneuver needs. 19 Heart rate showed the smallest change compared to other parameters.…”

Evaluation of Alternative Airway Devices in University and Educational and Research Hospital Emergency Departments in Turkey

“…glottic views than the direct laryngoscope, revealing a high intubation success rate in patients with difficult airway (37)(38)(39). While the intubation success rate for GVL has been demonstrated to be 90%-92% in previous studies, the intubation success rates for GVL and ILMA were demonstrated to be close at over 90% in Cinar et al 's study (31).…”

Intubation in the ICU: We Could Improve our Practice

“…In recent years, the role of videolaryngoscopes has been debated, particularly in the ICU where there has been a lack of scientifi c evidence and generally intubation conditions are more diffi cult than in the operating room [26]. Recently, however, videolaryngoscopes, such as C-Mac [27], [28] or Glide-scope [29], [30], have demonstrated their eff ectiveness in the ICU setting. Moreover, a recent study [31] assessed a new mixed videolaryngoscope that can be used as a direct or indirect view laryngoscope.…”