Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study.
Journal
British journal of anaesthesia
Journal Volume
131
Journal Issue
3
Start Page
607
End Page
616
ISSN
1471-6771
Date Issued
2023-09
Author(s)
Russotto, Vincenzo
Lascarrou, Jean Baptiste
Tassistro, Elena
Parotto, Matteo
Antolini, Laura
Bauer, Philippe
Szułdrzyński, Konstanty
Camporota, Luigi
Putensen, Christian
Pelosi, Paolo
Sorbello, Massimiliano
Higgs, Andy
Greif, Robert
Grasselli, Giacomo
Valsecchi, Maria G
Fumagalli, Roberto
Foti, Giuseppe
Caironi, Pietro
Bellani, Giacomo
Laffey, John G
Myatra, Sheila N
INTUBE Study Investigators
et al.
Abstract
Background: Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. Methods: This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy. Results: Of 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P=0.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P<0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05–1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95–1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60–1.02). Conclusions: In critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events. Clinical trial registration: NCT03616054.
Subjects
INTUBE study
adverse events
airway management
critical care
tracheal intubation
videolaryngoscopy
SDGs
Publisher
Elsevier Ltd
Type
journal article