Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit

Persistent Link:
http://hdl.handle.net/10150/610130
Title:
Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit
Author:
Mosier, Jarrod; Whitmore, Sage; Bloom, John; Snyder, Linda; Graham, Lisa; Carr, Gordon; Sakles, John
Affiliation:
Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA; Department of Medicine, Section of Pulmonary, Critical Care, Allergy and Sleep, University of Arizona, 1609 N Warren, FOB 122C, Tucson, AZ 85719, USA
Issue Date:
2013
Publisher:
BioMed Central
Citation:
Mosier et al. Critical Care 2013, 17:R237 http://ccforum.com/content/17/5/R237
Journal:
Critical Care
Rights:
© 2013 Mosier et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)
Collection Information:
This item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.
Abstract:
INTRODUCTION:Tracheal intubation in the Intensive Care Unit (ICU) can be challenging as patients often have anatomic and physiologic characteristics that make intubation particularly difficult. Video laryngoscopy (VL) has been shown to improve first attempt success compared to direct laryngoscopy (DL) in many clinical settings and may be an option for ICU intubations.METHODS:All intubations performed in this academic medical ICU during a 13-month period were entered into a prospectively collected quality control database. After each intubation, the operator completed a standardized form evaluating multiple aspects of the intubation including: patient demographics, difficult airway characteristics (DACs), method and device(s) used, medications used, outcomes and complications of each attempt. Primary outcome was first attempt success. Secondary outcomes were grade of laryngoscopic view, ultimate success, esophageal intubations, and desaturation. Multivariate logistic regression was performed for first attempt and ultimate success.RESULTS:Over the 13-month study period (January 2012-February 2013), a total of 234 patients were intubated using VL and 56 patients were intubated with DL. First attempt success for VL was 184/234 (78.6%; 95% CI 72.8 to 83.7) while DL was 34/56 patients (60.7%; 95% CI 46.8 to 73.5). Ultimate success for VL was 230/234 (98.3%; 95% CI 95.1 to 99.3) while DL was 52/56 patients (91.2%; 95% CI 81.3 to 97.2). In the multivariate regression model, VL was predictive of first attempt success with an odds ratio of 7.67 (95% CI 3.18 to 18.45). VL was predictive of ultimate success with an odds ratio of 15.77 (95% CI 1.92 to 129). Cormack-Lehane I or II view occurred 199/234 times (85.8%; 95% CI 79.5 to 89.1) and a median POGO (Percentage of Glottic Opening) of 82% (IQR 60 to 100) with VL, while Cormack-Lehane I or II view occurred 34/56 times (61.8%; 95% CI 45.7 to 71.9) and a median POGO of 45% (IQR 0 to 78%) with DL. VL reduced the esophageal intubation rate from 12.5% with DL to 1.3% (P = 0.001) but there was no difference in desaturation rates.CONCLUSIONS:In the medical ICU, video laryngoscopy resulted in higher first attempt and ultimate intubation success rates and improved grade of laryngoscopic view while reducing the esophageal intubation rate compared to direct laryngoscopy.
EISSN:
1466-609X
DOI:
10.1186/cc13061
Version:
Final published version
Additional Links:
http://ccforum.com/content/17/5/R237

Full metadata record

DC FieldValue Language
dc.contributor.authorMosier, Jarroden
dc.contributor.authorWhitmore, Sageen
dc.contributor.authorBloom, Johnen
dc.contributor.authorSnyder, Lindaen
dc.contributor.authorGraham, Lisaen
dc.contributor.authorCarr, Gordonen
dc.contributor.authorSakles, Johnen
dc.date.accessioned2016-05-20T08:59:14Z-
dc.date.available2016-05-20T08:59:14Z-
dc.date.issued2013en
dc.identifier.citationMosier et al. Critical Care 2013, 17:R237 http://ccforum.com/content/17/5/R237en
dc.identifier.doi10.1186/cc13061en
dc.identifier.urihttp://hdl.handle.net/10150/610130-
dc.description.abstractINTRODUCTION:Tracheal intubation in the Intensive Care Unit (ICU) can be challenging as patients often have anatomic and physiologic characteristics that make intubation particularly difficult. Video laryngoscopy (VL) has been shown to improve first attempt success compared to direct laryngoscopy (DL) in many clinical settings and may be an option for ICU intubations.METHODS:All intubations performed in this academic medical ICU during a 13-month period were entered into a prospectively collected quality control database. After each intubation, the operator completed a standardized form evaluating multiple aspects of the intubation including: patient demographics, difficult airway characteristics (DACs), method and device(s) used, medications used, outcomes and complications of each attempt. Primary outcome was first attempt success. Secondary outcomes were grade of laryngoscopic view, ultimate success, esophageal intubations, and desaturation. Multivariate logistic regression was performed for first attempt and ultimate success.RESULTS:Over the 13-month study period (January 2012-February 2013), a total of 234 patients were intubated using VL and 56 patients were intubated with DL. First attempt success for VL was 184/234 (78.6%en
dc.description.abstract95% CI 72.8 to 83.7) while DL was 34/56 patients (60.7%en
dc.description.abstract95% CI 46.8 to 73.5). Ultimate success for VL was 230/234 (98.3%en
dc.description.abstract95% CI 95.1 to 99.3) while DL was 52/56 patients (91.2%en
dc.description.abstract95% CI 81.3 to 97.2). In the multivariate regression model, VL was predictive of first attempt success with an odds ratio of 7.67 (95% CI 3.18 to 18.45). VL was predictive of ultimate success with an odds ratio of 15.77 (95% CI 1.92 to 129). Cormack-Lehane I or II view occurred 199/234 times (85.8%en
dc.description.abstract95% CI 79.5 to 89.1) and a median POGO (Percentage of Glottic Opening) of 82% (IQR 60 to 100) with VL, while Cormack-Lehane I or II view occurred 34/56 times (61.8%en
dc.description.abstract95% CI 45.7 to 71.9) and a median POGO of 45% (IQR 0 to 78%) with DL. VL reduced the esophageal intubation rate from 12.5% with DL to 1.3% (P = 0.001) but there was no difference in desaturation rates.CONCLUSIONS:In the medical ICU, video laryngoscopy resulted in higher first attempt and ultimate intubation success rates and improved grade of laryngoscopic view while reducing the esophageal intubation rate compared to direct laryngoscopy.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urlhttp://ccforum.com/content/17/5/R237en
dc.rights© 2013 Mosier et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0)en
dc.titleVideo laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care uniten
dc.typeArticleen
dc.identifier.eissn1466-609Xen
dc.contributor.departmentDepartment of Emergency Medicine, University of Arizona, Tucson, AZ, USAen
dc.contributor.departmentDepartment of Medicine, Section of Pulmonary, Critical Care, Allergy and Sleep, University of Arizona, 1609 N Warren, FOB 122C, Tucson, AZ 85719, USAen
dc.identifier.journalCritical Careen
dc.description.collectioninformationThis item is part of the UA Faculty Publications collection. For more information this item or other items in the UA Campus Repository, contact the University of Arizona Libraries at repository@u.library.arizona.edu.en
dc.eprint.versionFinal published versionen
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