Endotracheal tube-mounted camera-assisted intubation versus conventional intubation in intensive care: a prospective, randomised trial (VivaITN)

Abstract

BackgroundFor critically ill patients, effective airway management with a high first-attempt success rate for endotracheal intubation is essential to prevent hypoxic complications during securing of the airway. Video guidance may improve first-attempt success rate over direct laryngoscopy (DL).MethodsWith ethics approval, this randomised controlled trial involved 54 critically ill patients who received endotracheal intubation using a tube with an integrated video camera (VivaSight™-SL tube, VST, ETView Ltd., Misgav, Israel) or using conventional intubation under DL.ResultsThe two groups did not differ in terms of intubation conditions. The first-attempt success rate was VST 96% vs. DL 93% (not statistically significant (n. s.)). When intubation at first attempt failed, it was successful in the second attempt in all patients. There was no difference in the median average time to intubation (VST 34 s (interquartile range 28–39) vs. DL 35 s (28–40), n. s.). Neither vomiting nor aspiration or accidental oesophageal intubation were observed in either group. The lowest pulsoxymetric oxygen saturation for VST was 96 (82–99) % vs. 99 (95–100) % for DL (n. s.). Hypotension defined as systolic blood pressure < 70 mmHg occurred in the VST group at 20% vs. the DL group at 15% (n. s.).ConclusionIn this pilot study, no advantage was shown for the VST. The VST should be examined further to identify patient groups that could benefit from intubation with the VST, that is, patients with difficult airway conditions.Trial registrationClinicalTrials.gov, NCT02837055. Registered on 13 June 2016.

Comparison of McGrath, Pentax, and Macintosh laryngoscope in normal and cervical immobilized manikin by novices: a randomized crossover trial

“…The results of manikin studies may not be replicated in real patients due to several reasons. During intubation of real patients, various airway secretions may obstruct the view of the videolaryngoscope lens, rendering them useless [ 30 ]. Furthermore, although we have created a difficult airway situation via cervical immobilization in the manikin, there are numerous additional situations that comprise a difficult airway situation in real life, such as obesity, or a large tongue.…”

Tracheal Tube-Mounted Camera Assisted Intubation vs. Videolaryngoscopy in Expected Difficult Airway: A Prospective, Randomized Trial (VivaOP Trial)

“…For VL, an overall intubation time of approximately 50–60 s has been reported in human subjects with a difficult airway ( 31 ). For the VST, approximately 30 s have been reported previously, but these results were obtained in patients without difficult airways ( 6 ). This contrasts with the required duration for intubation in our study with the VST needing nearly three times longer, only counting intubations that were successful on first attempt.…”

“…So far, the VST has been evaluated for tracheal intubation in patients with a predicted non-difficult airway in intensive care ( 6 ), in patients with morbid obesity ( 7 ), via supraglottic airway devices ( 15 , 16 ), in manikins ( 17 – 21 ), in a cadaver study ( 22 ), and for the guidance of percutaneous dilatational tracheostomy ( 23 , 24 ).…”

“…Recently, a tracheal tube with an integrated camera has been introduced (VST, VivaSight-SL, Ambu A/S, Ballerup, Denmark) that may allow for direct guidance of the tube and may aid in tracheal intubation in patients with difficult airways ( 5 ). This tube has been evaluated under the clinical conditions in intensive care patients ( 6 ) and patients with morbid adiposity compared with DL ( 7 ), but there is a paucity of data in patients with difficult airways, so far. As opposed to VL, the camera axis of VST may be adjusted individually by modifying the angulation of a stylet and by direct steering of the tip of the tube during tube advancement which may provide a benefit in the cases of difficult airways.…”

Optical Devices in Tracheal Intubation—State of the Art in 2020

“…In these situations, the VivaSight© SLT guided bronchial blocker for one-lung ventilation can be used with advantage [ 111 , 112 ]. VivaSight SLT has been compared with Macintosh direct laryngoscopy in critically ill patients requiring tracheal intubation [ 113 ]. It did not show any benefit in terms of success rate or speed of intubation.…”