Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults

Prekker, Matthew E.; Trent, Stacy A.; Resnick-Ault, Daniel; Seitz, Kevin P.; Russell, Derek W.; Gaillard, J; Latimer, Andrew J.; Ghamande, Shekhar; Gibbs, Kevin W.; Vonderhaar, Derek J; Whitson, Matthew J.; Barnes, Christopher; Walco, Jeremy P.; Douglas, Ivor S.; Krishnamoorthy, Vijay; Dagan, Alon; Bastman, Jill J.; Lloyd, Bradley D.; Gandotra, Sheetal; Goranson, Jordan Kugler; Mitchell, Steven H.; White, Heath; Palakshappa, Jessica A.; Espinera, Alyssa; Page, David B.; Joffe, Aaron M.; Hansen, Sydney J.; Hughes, Christopher G.; George, Tobias; Herbert, James T.; Shapiro, Nathan I.; Schauer, Steven G; Long, Brit; Imhoff, Brant; Wang, Li; Rhoads, Jillian P.; Womack, Kelsey N.; Janz, David R.; Self, Wesley H.; Rice, Todd W.; Ginde, Adit A.; Casey, Jonathan D; Semler, Matthew W.

doi:10.1056/nejmoa2301601

Cited by 128 publications

(52 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fifth, the use of bougie or videolaryngoscope were not recorded. However, the observed first pass failure was similar to previous trials on intubation . Sixth, the GCS was not explicitly designed to guide clinical prediction of the risk of aspiration or need for tracheal intubation.…”

Section: Discussionmentioning

confidence: 71%

“…This finding may fill a gap in the existing literature that was controversial and suggested that intubating patients for airway protection to limit the risk of aspiration pneumonia may in fact increase the risk of pneumonia. Fourth, the first pass failure rate was monitored as a validated surrogate for adverse events, and among those intubated, the rate was lower for the intervention group compared with the control group …”

Section: Discussionmentioning

confidence: 99%

“…Total hospital costs and costs consequence analysis were also part of secondary outcomes but are not described in the present analysis. Prior to the completion of recruitment and data analysis, a prespecified analysis of the proportion of first pass failures, which is associated with an increased risk of adverse events, was added to the analysis plan …”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning

Freund,

Viglino,

Cachanado

et al. 2023

JAMA

View full text Add to dashboard Cite

ImportanceTracheal intubation is recommended for coma patients and those with severe brain injury, but its use in patients with decreased levels of consciousness from acute poisoning is uncertain.ObjectiveTo determine the effect of intubation withholding vs routine practice on clinical outcomes of comatose patients with acute poisoning and a Glasgow Coma Scale score less than 9.Design, Setting, and ParticipantsThis was a multicenter, randomized trial conducted in 20 emergency departments and 1 intensive care unit (ICU) that included comatose patients with suspected acute poisoning and a Glasgow Coma Scale score less than 9 in France between May 16, 2021, and April 12, 2023, and followed up until May 12, 2023.InterventionPatients were randomized to undergo conservative airway strategy of intubation withholding vs routine practice.Main Outcomes and MeasuresThe primary outcome was a hierarchical composite end point of in-hospital death, length of ICU stay, and length of hospital stay. Key secondary outcomes included adverse events resulting from intubation as well as pneumonia within 48 hours.ResultsAmong the 225 included patients (mean age, 33 years; 38% female), 116 were in the intervention group and 109 in the control group, with respective proportions of intubations of 16% and 58%. No patients died during the in-hospital stay. There was a significant clinical benefit for the primary end point in the intervention group, with a win ratio of 1.85 (95% CI, 1.33 to 2.58). In the intervention group, there was a lower proportion with any adverse event (6% vs 14.7%; absolute risk difference, 8.6% [95% CI, −16.6% to −0.7%]) compared with the control group, and pneumonia occurred in 8 (6.9%) and 16 (14.7%) patients, respectively (absolute risk difference, −7.8% [95% CI, −15.9% to 0.3%]).Conclusions and RelevanceAmong comatose patients with suspected acute poisoning, a conservative strategy of withholding intubation was associated with a greater clinical benefit for the composite end point of in-hospital death, length of ICU stay, and length of hospital stay.Trial RegistrationClinicalTrials.gov Identifier: NCT04653597

show abstract

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning

Freund,

Viglino,

Cachanado

et al. 2023

JAMA

View full text Add to dashboard Cite

show abstract

“…Previous studies were discordant regarding the benefits of systematic videolaryngoscopy use for ETI [20,21]. However, a recent study dedicated to ETI in the ED on over 1400 patients revealed that the regular systematic use of a videolaryngoscope for ETI resulted in higher first-pass success compared to direct laryngoscopy [22]. This outcome was observed even for operators who performed less than 100 ETI.…”

Section: Videolaryngoscopymentioning

confidence: 99%

Training approaches and devices utilization during endotracheal intubation in French Emergency Departments: a nationwide survey

Le Borgne,

Alamé,

Chenou

et al. 2023

European Journal of Emergency Medicine

View full text Add to dashboard Cite

Background and importance Endotracheal intubation is a lifesaving procedure that is reportedly associated to a significant risk of adverse events. Recent trials have reported that the use of videolaryngoscope and of a stylet might limit this risk during emergency intubation. Objectives The objective of this study was to provide a national description of intubation practices in French Emergency Departments (EDs). Settings and participants We conducted an online nationwide survey by sending an anonymous 37-item questionnaire via e-mail to 629 physicians in French EDs between 2020 and 2022. Intervention A single questionnaire was sent to a sole referent physician in each ED. Outcome measures and analysis The primary endpoint was to assess the proportion of French EDs in which videolaryngoscopy was available for emergency intubation and its use in routine practice. Secondary endpoints included the presence of local protocol or standard of procedure for intubation, availability of capnography, and routine use of a stylet. Main results Of the surveyed EDs, 342 (54.4%) returned the completed questionnaire. A videolaryngoscope was available in 193 (56%) EDs, and direct laryngoscopy without a stylet was majorly used as the primary approach in 280 (82%) EDs. Among the participating EDs, 74% had an established protocol for intubation and 92% provided a capnography device for routine verification of tube position. In cases of difficult intubation, the use of a bougie was recommended in 227 (81%) EDs, and a switch to a videolaryngoscope in 16 (6%) EDs. The most frequently used videolaryngoscope models were McGrath Mac Airtraq (51%), followed by Airtraq (41%), and Glidescope (14%). Conclusion In this large French survey, the majority of EDs recommended direct laryngoscopy without stylet, with seldom use of videolaryngoscopy.

show abstract

“…Conducting large trials to improve outcomes for ECMO patients will require support from federal funders and the creation of ECMO-specific clinical trial networks capable of leading efficient, pragmatic comparative effectiveness trials like those conducted for other emergency procedures like emergency tracheal intubation (22, 23) and outside-of-hospital cardiac arrest (24). Early efforts like these are already underway with pilot studies in anticoagulation (NCT04997265, NCT04273607), protocolized weaning (NCT05486559), and mechanical ventilation management (NCT05708365).…”

mentioning

confidence: 99%

Climbing the Evidence Pyramid: Developing an Evidence-Based Approach to the Provision of Venovenous Extracorporeal Membrane Oxygenation*

Gannon,

Teijeiro-Paradis,

Prekker

et al. 2023

Critical Care Medicine

Self Cite

View full text Add to dashboard Cite

Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults

Cited by 128 publications

References 39 publications

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning

Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning

Training approaches and devices utilization during endotracheal intubation in French Emergency Departments: a nationwide survey

Climbing the Evidence Pyramid: Developing an Evidence-Based Approach to the Provision of Venovenous Extracorporeal Membrane Oxygenation*

Contact Info

Product

Resources

About