Video Laryngoscopy Improves Odds of First Attempt Success at Intubation in the ICU: A Propensity-Matched Analysis

Cameron D Hypes, Uwe Stolz, John C Sakles, Raj R Joshi, Bhupinder Natt, Josh Malo, John W Bloom, and Jarrod M Mosier

Jarrod Mosier and John Sakles continue to be among leaders in clinical evaluation of airway management in ICU and ED areas. This article reinforces the growing understanding that in ICU , where most caregivers are no longer from an anesthesiology training base but from various other disciplines, the Video Laryngoscope is easier to learn and use. The skill retention is also superior using VL so overall performance for first pass success is superior to DL.
The Abstract for ICU application is as follows:

Abstract

 Rationale: Urgent tracheal intubation is performed frequently in intensive care units and incurs higher risk than when intubation is performed under more controlled circumstances. Video laryngoscopy may improve the chances of successful tracheal intubation on the first attempt; however existing comparative data on outcomes are limited. 

Objectives: To compare first attempt success and complication rates during intubation when using video laryngoscopy compared to traditional direct laryngoscopy in a tertiary academic medical intensive care unit. Methods: We prospectively collected and analyzed data from a continuous quality improvement database of all intubations in one medical intensive care unit between January 1st, 2012 and December 31st 2014. Propensity-matching and multivariable logistic regression were used to reduce the risk of bias and control for confounding.

 Measurements and Main Results: A total of 885 intubations took place over the study period. Of these, 673 (83.2%) were performed using video laryngoscopy and 

136 (16.8%) using direct laryngoscopy. 

First attempt success with video laryngoscopy was 80.4% (95% CI 77.2 to 83.3%) compared and 65.4% (95% CI: 56.8 to 73.4%) for intubations performed with direct laryngoscopy, p=<0.001. In a propensity-matched analysis, the odds ratio for first attempt success with video laryngoscopy vs. direct laryngoscopy was 2.81 (95% CI 2.27 to 3.59). The rate of arterial oxygen saturation events during the first intubation attempt was significantly lower for video laryngoscopy than for direct laryngoscopy (18.3% vs. 25.9%, p=0.04). The rate of esophageal intubation during any attempt was also significantly lower for video laryngoscopy (2.1% vs. 6.6%, p=0.008). 

Conclusions: Video laryngoscopy was associated with significantly improved odds of first attempt success at tracheal intubation by non-anesthesiologists in a medical intensive care unit. Esophageal intubation and oxygen desaturation complicating intubation occurred less frequently with the use of video laryngoscopy. Randomized clinical trials are needed to confirm these findings.

Read More: http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201508-505OC#.VniHCTa0GfM