To evaluate the effect of video laryngoscopy
on the rate of endotracheal intubation
on first laryngoscopy
attempt among critically ill adults.
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.
Medical ICU in a tertiary, academic medical center.
Critically ill patients 18 years old or older.
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 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
In critically ill adults undergoing endotracheal intubation
, video laryngoscopy
improves glottic visualization but does not appear to increase procedural success or decrease complications.