Journal Article

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

Conseil, Matthieu, Cisse, Moussa, Jung, Boris, Clavieras, Noémie, Chanques, Gérald, Pouzeratte, Yvan, Coisel, Yannael, De Jong, Audrey, Jaber, Samir, Moury, Pierre-Henri, Belafia, Fouad, Molinari, Nicolas

2013

Overview

Purpose Airway management in intensive care unit (ICU) patients is challenging. The main objective of this study was to compare the incidence of difficult laryngoscopy and/or difficult intubation between a combo videolaryngoscope and the standard Macintosh laryngoscope in critically ill patients. Methods In the context of the implementation of a quality-improvement process for airway management, we performed a prospective interventional monocenter before–after study which evaluated a new combo videolaryngoscope. The primary outcome was the incidence of difficult laryngoscopy (defined by Cormack grade 3–4) and/or difficult intubation (more than two attempts). The secondary outcomes were the severe life-threatening complications related to intubation in ICU and the rate of difficult intubation in cases of predicted difficult intubation evaluated by a specific score (MACOCHA score ≥3). Results Two hundred and ten non-selected consecutive intubation procedures were included, 140 in the standard laryngoscope group and 70 in the combo videolaryngoscope group. The incidence of difficult laryngoscopy and/or difficult intubation was 16 % in the laryngoscope group vs. 4 % in the combo videolaryngoscope group ( p  = 0.01). The severe life-threatening complications related to intubation did not differ between groups (16 vs. 14 %, p  = 0.79). Among the 32 patients with a MACOCHA score ≥3, there were significantly more patients with difficult intubation in the standard laryngoscope group in comparison to the combo videolaryngoscope group [12/23 (57 %) vs. 0/9 (0 %), p  < 0.01]. Conclusions The systematic use of a combo videolaryngoscope in ICU was associated with a decreased incidence of difficult laryngoscopy and/or difficult intubation.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V,Springer Verlag
• Subject: Aged / Airway management / Algorithms / Anesthesiology / Care and treatment / Critical care / Critical Care Medicine / Critical Illness - therapy / Critically ill / Emergency Medicine / Female / Human health and pathology / Humans / Incidence / Intensive / Intensive care / Intensive care units / Intubation / Intubation, Intratracheal - adverse effects / Intubation, Intratracheal - methods / Laryngoscopy / Laryngoscopy - adverse effects / Laryngoscopy - methods / Life Sciences / Male / Medicine / Medicine & Public Health / Methods / Middle Aged / Original / Pain Medicine / Pediatrics / Pneumology/Respiratory System / Services / Teaching hospitals