Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before–after comparative study

Jong, Audrey De; Clavieras, Noémie; Conseil, Matthieu; Coisel, Yannaël; Moury, Pierre-Henri; Pouzeratte, Y.; Cissé, Moussa; Belafia, Fouad; Jung, Boris; Chanques, Gérald; Molinari, Nicolas; Jaber, Samir

doi:10.1007/s00134-013-3099-1

Cited by 78 publications

(104 citation statements)

References 33 publications

(57 reference statements)

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“…These results agree with those of the ICU study by Griesdale et al [10] who found that intubation using the GlidescopeÒ videolaryngoscope resulted in lower oxygen saturation. On the other hand, De Jong et al [9] showed a significant reduction in the incidence of difficult laryngoscopy and/or difficult intubation with the McGrath videolaryngoscope (4 vs. 16 %) in ICU patients.…”

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confidence: 98%

“…De Jong et al [9] found no differences in mortality or major complications between the use of conventional laryngoscopes and the videolaryngoscopes. This result is to be expected since the study was probably underpowered in this regard.…”

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confidence: 98%

“…To our knowledge five recent studies have evaluated the application of videolaryngoscopes in the ICU [9][10][11][12][13]. The study by De Jong et al [9] from the Montpellier group reported in this issue of Intensive Care Medicine is the first to evaluate the McGrath Mac (Aircraft Medical, Edinburgh, Scotland), a videolaryngoscope with a Macintosh-like blade that allows intubation using conventional direct laryngoscopy or indirect (video) laryngoscopy.…”

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confidence: 99%

“…The study by De Jong et al [9] from the Montpellier group reported in this issue of Intensive Care Medicine is the first to evaluate the McGrath Mac (Aircraft Medical, Edinburgh, Scotland), a videolaryngoscope with a Macintosh-like blade that allows intubation using conventional direct laryngoscopy or indirect (video) laryngoscopy. The results reported by these authors are in agreement with those from other studies, i.e., it is easier to visualize the glottis using the videolaryngoscope and fewer intubation attempts are required.…”

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confidence: 99%

“…The multivariate analysis performed by De Jong et al [9] revealed that difficult intubation was associated with direct laryngoscopy using the Macintosh technique, Cormack III-IV in that the glottis cannot be visualized and the inexperience of the operator. In their study the majority of the operators in both groups were inexperienced which may have affected the results.…”

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confidence: 99%

See 4 more Smart Citations

Videolaryngoscopy: towards a new standard method for tracheal intubation in the ICU?

Larsson

Dhonneur

2013

Intensive Care Med

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confidence: 98%

mentioning

confidence: 98%

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confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Videolaryngoscopy: towards a new standard method for tracheal intubation in the ICU?

Larsson

Dhonneur

2013

Intensive Care Med

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Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients

Lascarrou

Boisramé-Helms

Bailly

et al. 2017

JAMA

204

184

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Intensive Care and Sepsis (CRICS) Group IMPORTANCE In the intensive care unit (ICU), orotracheal intubation can be associated with increased risk of complications because the patient may be acutely unstable, requiring prompt intervention, often by a practitioner with nonexpert skills. Video laryngoscopy may decrease this risk by improving glottis visualization. OBJECTIVE To determine whether video laryngoscopy increases the frequency of successful first-pass orotracheal intubation compared with direct laryngoscopy in ICU patients.DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 371 adults requiring intubation while being treated at 7 ICUs in France between May 2015 and January 2016; there was 28 days of follow-up.INTERVENTIONS Intubation using a video laryngoscope (n = 186) or direct laryngoscopy (n = 185). All patients received general anesthesia. MAIN OUTCOMES AND MEASURESThe primary outcome was the proportion of patients with successful first-pass intubation. The secondary outcomes included time to successful intubation and mild to moderate and severe life-threatening complications. RESULTS Among 371 randomized patients (mean [SD] age, 62.8 [15.8] years; 136 [36.7%] women), 371 completed the trial. The proportion of patients with successful first-pass intubation did not differ significantly between the video laryngoscopy and direct laryngoscopy groups (67.7% vs 70.3%; absolute difference, −2.5% [95% CI, −11.9% to 6.9%]; P = .60). The proportion of first-attempt intubations performed by nonexperts (primarily residents, n = 290) did not differ between the groups (84.4% with video laryngoscopy vs 83.2% with direct laryngoscopy; absolute difference 1.2% [95% CI, −6.3% to 8.6%]; P = .76). The median time to successful intubation was 3 minutes (range, 2 to 4 minutes) for both video laryngoscopy and direct laryngoscopy (absolute difference, 0 [95% CI, 0 to 0]; P = .95). Video laryngoscopy was not associated with life-threatening complications (24/180 [13.3%] vs 17/179 [9.5%] for direct laryngoscopy; absolute difference, 3.8% [95% CI, −2.7% to 10.4%]; P = .25). In post hoc analysis, video laryngoscopy was associated with severe life-threatening complications (17/179 [9.5%] vs 5/179 [2.8%] for direct laryngoscopy; absolute difference, 6.7% [95% CI, 1.8% to 11.6%]; P = .01) but not with mild to moderate life-threatening complications (10/181 [5.4%] vs 14/181 [7.7%]; absolute difference, −2.3% [95% CI, −7.4% to 2.8%]; P = .37).CONCLUSIONS AND RELEVANCE Among patients in the ICU requiring intubation, video laryngoscopy compared with direct laryngoscopy did not improve first-pass orotracheal intubation rates and was associated with higher rates of severe life-threatening complications. Further studies are needed to assess the comparative effectiveness of these 2 strategies in different clinical settings and among operators with diverse skill levels.

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Intubation With Video Laryngoscopy vs Direct Laryngoscopy—Reply

Lascarrou

Thuaut

Reignier

2017

JAMA

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Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before–after comparative study

Abstract: The systematic use of a combo videolaryngoscope in ICU was associated with a decreased incidence of difficult laryngoscopy and/or difficult intubation.

Cited by 78 publications

References 33 publications

Videolaryngoscopy: towards a new standard method for tracheal intubation in the ICU?

Videolaryngoscopy: towards a new standard method for tracheal intubation in the ICU?

Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients

Intubation With Video Laryngoscopy vs Direct Laryngoscopy—Reply

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