Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults.

Janz, David R; Semler, Matthew W; Lentz, Robert J; Matthews, Daniel T; Assad, Tufik R; Norman, Brett C; Keriwala, Raj D; Ferrell, Benjamin A; Noto, Michael J; Shaver, Ciara M; Richmond, Bradley W; Zinggeler Berg, Jeannette; Rice, Todd W

OBJECTIVE To evaluate the effect of video laryngoscopy on the rate of endotracheal intubation on first laryngoscopy attempt among critically ill adults. DESIGN A randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows. SETTING Medical ICU in a tertiary, academic medical center. PATIENTS Critically ill patients 18 years old or older. INTERVENTIONS Patients were randomized 1:1 to video or direct laryngoscopy for the first attempt at endotracheal intubation. MEASUREMENTS AND MAIN RESULTS Patients assigned to video (n = 74) and direct (n = 76) laryngoscopy were similar at baseline. Despite better glottic visualization with video laryngoscopy, there was no difference in the primary outcome of intubation on the first laryngoscopy attempt (video 68.9% vs direct 65.8%; p = 0.68) in unadjusted analyses or after adjustment for the operator's previous experience with the assigned device (odds ratio for video laryngoscopy on intubation on first attempt 2.02; 95% CI, 0.82-5.02, p = 0.12). Secondary outcomes of time to intubation, lowest arterial oxygen saturation, complications, and in-hospital mortality were not different between video and direct laryngoscopy. CONCLUSIONS In critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications.