Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room : A Cluster Randomized Clinical Trial
Importance: Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear.
Objective: To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy.
Design, Setting, and Participants: Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat.
Interventions: Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt.
Main Outcomes and Measures: The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries.
Results: Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]).
Conclusion and Relevance: In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures.
Trial Registration: ClinicalTrials.gov Identifier: NCT04701762.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:331 |
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| Enthalten in: |
JAMA - 331(2024), 15 vom: 16. Apr., Seite 1279-1286 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ruetzler, Kurt [VerfasserIn] |
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| Links: |
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| Themen: |
Comparative Study |
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| Anmerkungen: |
Date Completed 17.04.2024 Date Revised 21.04.2024 published: Print ClinicalTrials.gov: NCT04701762 Citation Status MEDLINE |
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| doi: |
10.1001/jama.2024.0762 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369876768 |
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| 100 | 1 | |a Ruetzler, Kurt |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room |b A Cluster Randomized Clinical Trial |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 17.04.2024 | ||
| 500 | |a Date Revised 21.04.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT04701762 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Importance: Endotracheal tubes are typically inserted in the operating room using direct laryngoscopy. Video laryngoscopy has been reported to improve airway visualization; however, whether improved visualization reduces intubation attempts in surgical patients is unclear | ||
| 520 | |a Objective: To determine whether the number of intubation attempts per surgical procedure is lower when initial laryngoscopy is performed using video laryngoscopy or direct laryngoscopy | ||
| 520 | |a Design, Setting, and Participants: Cluster randomized multiple crossover clinical trial conducted at a single US academic hospital. Patients were adults aged 18 years or older having elective or emergent cardiac, thoracic, or vascular surgical procedures who required single-lumen endotracheal intubation for general anesthesia. Patients were enrolled from March 30, 2021, to December 31, 2022. Data analysis was based on intention to treat | ||
| 520 | |a Interventions: Two sets of 11 operating rooms were randomized on a 1-week basis to perform hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt | ||
| 520 | |a Main Outcomes and Measures: The primary outcome was the number of operating room intubation attempts per surgical procedure. Secondary outcomes were intubation failure, defined as the responsible clinician switching to an alternative laryngoscopy device for any reason at any time, or by more than 3 intubation attempts, and a composite of airway and dental injuries | ||
| 520 | |a Results: Among 8429 surgical procedures in 7736 patients, the median patient age was 66 (IQR, 56-73) years, 35% (2950) were women, and 85% (7135) had elective surgical procedures. More than 1 intubation attempt was required in 77 of 4413 surgical procedures (1.7%) randomized to receive video laryngoscopy vs 306 of 4016 surgical procedures (7.6%) randomized to receive direct laryngoscopy, with an estimated proportional odds ratio for the number of intubation attempts of 0.20 (95% CI, 0.14-0.28; P < .001). Intubation failure occurred in 12 of 4413 surgical procedures (0.27%) using video laryngoscopy vs 161 of 4016 surgical procedures (4.0%) using direct laryngoscopy (relative risk, 0.06; 95% CI, 0.03-0.14; P < .001) with an unadjusted absolute risk difference of -3.7% (95% CI, -4.4% to -3.2%). Airway and dental injuries did not differ significantly between video laryngoscopy (41 injuries [0.93%]) vs direct laryngoscopy (42 injuries [1.1%]) | ||
| 520 | |a Conclusion and Relevance: In this study among adults having surgical procedures who required single-lumen endotracheal intubation for general anesthesia, hyperangulated video laryngoscopy decreased the number of attempts needed to achieve endotracheal intubation compared with direct laryngoscopy at a single academic medical center in the US. Results suggest that video laryngoscopy may be a preferable approach for intubating patients undergoing surgical procedures | ||
| 520 | |a Trial Registration: ClinicalTrials.gov Identifier: NCT04701762 | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 700 | 1 | |a Bustamante, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Schmidt, Marc T |e verfasserin |4 aut | |
| 700 | 1 | |a Almonacid-Cardenas, Federico |e verfasserin |4 aut | |
| 700 | 1 | |a Duncan, Andra |e verfasserin |4 aut | |
| 700 | 1 | |a Bauer, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Turan, Alparslan |e verfasserin |4 aut | |
| 700 | 1 | |a Skubas, Nikolaos J |e verfasserin |4 aut | |
| 700 | 1 | |a Sessler, Daniel I |e verfasserin |4 aut | |
| 700 | 0 | |a Collaborative VLS Trial Group |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Jian |e investigator |4 oth | |
| 700 | 1 | |a Kumar, Nikhil |e investigator |4 oth | |
| 700 | 1 | |a Malackany, Natasha |e investigator |4 oth | |
| 700 | 1 | |a Maldonado, Yasdet |e investigator |4 oth | |
| 700 | 1 | |a Apostolakis, John |e investigator |4 oth | |
| 700 | 1 | |a Alfirevic, Andrej |e investigator |4 oth | |
| 700 | 1 | |a Kelava, Marta |e investigator |4 oth | |
| 700 | 1 | |a Haargrave, Jennifer |e investigator |4 oth | |
| 700 | 1 | |a Richardson, Ria |e investigator |4 oth | |
| 700 | 1 | |a Anthony, David |e investigator |4 oth | |
| 700 | 1 | |a Capdeville, Michelle |e investigator |4 oth | |
| 700 | 1 | |a Geube, Mariya |e investigator |4 oth | |
| 700 | 1 | |a Wakefield, Brett |e investigator |4 oth | |
| 700 | 1 | |a Kumar, Nakul |e investigator |4 oth | |
| 700 | 1 | |a Burbano, Vera |e investigator |4 oth | |
| 700 | 1 | |a Khanna, Sandeep |e investigator |4 oth | |
| 700 | 1 | |a Trombetta, Carlos |e investigator |4 oth | |
| 700 | 1 | |a Tovar-Camargo, Oscar |e investigator |4 oth | |
| 700 | 1 | |a Troianos, Christopher |e investigator |4 oth | |
| 700 | 1 | |a Mascha, Edward |e investigator |4 oth | |
| 700 | 1 | |a Han, Yanyan |e investigator |4 oth | |
| 700 | 1 | |a Yan, Dongsheng |e investigator |4 oth | |
| 700 | 1 | |a Roessler, Julian |e investigator |4 oth | |
| 700 | 1 | |a Ekrami, Elyad |e investigator |4 oth | |
| 700 | 1 | |a Yalcin Kutlu, Esra |e investigator |4 oth | |
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