DEVICE
Trial question
What is the role of videolaryngoscopy in critically ill adults undergoing tracheal intubation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
35.0% female
65.0% male
N = 1417
1417 patients (498 female, 919 male).
Inclusion criteria: critically ill adult patients undergoing tracheal intubation.
Key exclusion criteria: pregnancy; incarceration; immediate need for tracheal intubation; use of videolaryngoscope or direct laryngoscope on the first attempt indicated or contraindicated by operator.
Interventions
N=705 videolaryngoscopy (use of a laryngoscope with a camera and a video screen on the first attempt at laryngoscopy).
N=712 direct laryngoscopy (use of a laryngoscope without a camera or a video screen on the first attempt at laryngoscopy).
Primary outcome
Successful intubation on first attempt
85.1%
70.8%
85.1 %
63.8 %
42.5 %
21.3 %
0.0 %
Videolaryngoscopy
Direct
laryngoscopy
Significant
increase ▲
NNT = 6
Significant increase in successful intubation on the first attempt (85.1% vs. 70.8%; AD 14.3%, 95% CI 9.9 to 18.7).
Secondary outcomes
No significant difference in severe complication during intubation (21.4% vs. 20.9%; AD 0.5%, 95% CI -3.9 to 4.9).
Significant decrease in median duration of intubation (38 seconds vs. 46 seconds; AD -8 seconds, 95% CI -12 to -4).
Borderline significant increase in median ventilator-free days (24 days vs. 23 days; AD 1 days, 95% CI 0 to 2).
Safety outcomes
No significant differences in esophageal intubation, injury to teeth, operator-reported aspiration.
Conclusion
In critically ill adult patients undergoing tracheal intubation, videolaryngoscopy was superior to direct laryngoscopy with respect to successful intubation on the first attempt.
Reference
Matthew E Prekker, Brian E Driver, Stacy A Trent et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2023 Aug 3;389(5):418-429.
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