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 adults requiring intubation while being treated at 7 ICUs in France between May and January ; there was 28 days of follow-up. All patients received general anesthesia. Main outcomes and measures: The 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 randomized patients mean [SD] age, The proportion of patients with successful first-pass intubation did not differ significantly between the video laryngoscopy and direct laryngoscopy groups 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. Trial registration: clinicaltrials. Abstract 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.
Associated data ClinicalTrials.
