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

Janz, David R. MD, MSc; Semler, Matthew W. MD; Lentz, Robert J. MD; Matthews, Daniel T. MD; Assad, Tufik R. MD; Norman, Brett C. MD; Keriwala, Raj D. MD, MPH; Ferrell, Benjamin A. MD; Noto, Michael J. MD, PhD; Shaver, Ciara M. MD, PhD; Richmond, Bradley W. MD; Zinggeler Berg, Jeannette MD, PhD; Rice, Todd W. MD, MSc; for the Facilitating EndotracheaL intubation by Laryngoscopy technique and apneic Oxygenation Within the ICU Investigators and the Pragmatic Critical Care Research Group

doi: 10.1097/CCM.0000000000001841
Clinical Investigations

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.

1Department of Medicine, Section of Pulmonary and Critical Care Medicine Louisiana State University School of Medicine, New Orleans, LA.

2Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.

*See also p. 2106.

Drs. Semler, Janz, and Rice helped in study concept and design. Drs. Janz, Semler, Lentz, Matthews, Norman, Assad, Keriwala, Ferrell, Noto, Shaver, Richmond, and Zinggeler Berg helped in acquisition of the data. Drs. Janz, Semler, Lentz, Matthews, Norman, Assad, Keriwala, Ferrell, Noto, Shaver, Richmond, Zinggeler Berg, and Rice helped in data analysis and interpretation. Drs. Janz, Semler, and Rice helped in article preparation and drafting. Drs. Janz, Semler, and Rice helped in statistical methods and statistical data analysis. Drs. Janz, Semler, Lentz, Matthews, Norman, Assad, Keriwala, Ferrell, Noto, Shaver, Richmond, Zinggeler Berg, and Rice helped in article critique and review. All authors approved the article submitted. Drs. Janz, Semler, and Rice take responsibility for the integrity of the work as a whole.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported by a National Heart, Lung, and Blood Institute (NHLBI) T32 award (HL087738). Data collection utilized the Research Electronic Data Capture (REDCap) tool developed and maintained with Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH).

Dr. Janz received support for article research from the National Institutes of Health (NIH). Drs. Semler, Lentz, Assad, and Shaver received support for article research from the NIH. Their institutions received funding (Investigators conducting this study were supported by a National Heart, Lung, and Blood Institute [NHLBI] T32 award [HL087738]). Dr. Norman received support for article research from the NIH. Dr. Keriwala’s institution received funding (Investigators conducting this study were supported by a NHLBI T32 award [HL087738]). Dr. Richmond received support for article research from the NIH. Dr. Zinggeler Berg received support for article research from the NIH and disclosed other support (Investigators conducting this study were supported by a NHLBI T32 award [HL087738]). Dr. Rice received support for article research from the NIH and received funding from GlaxoSmithKline, LLC and AVISA Pharma, LLC. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: djanz@lsuhsc.edu

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