• Matthew E Prekker, Brian E Driver, Stacy A Trent, Daniel Resnick-Ault, Kevin P Seitz, Derek W Russell, John P Gaillard, Andrew J Latimer, Shekhar A Ghamande, Kevin W Gibbs, Derek J Vonderhaar, Micah R Whitson, Christopher R Barnes, Jeremy P Walco, Ivor S Douglas, Vijay Krishnamoorthy, Alon Dagan, Jill J Bastman, Bradley D Lloyd, Sheetal Gandotra, Jordan K Goranson, Steven H Mitchell, Heath D White, Jessica A Palakshappa, Alyssa Espinera, David B Page, Aaron Joffe, Sydney J Hansen, Christopher G Hughes, Tobias George, J Taylor Herbert, Nathan I Shapiro, Steven G Schauer, Brit J Long, Brant Imhoff, Li Wang, Jillian P Rhoads, Kelsey N Womack, David R Janz, Wesley H Self, Todd W Rice, Adit A Ginde, Jonathan D Casey, Matthew W Semler, and DEVICE Investigators and the Pragmatic Critical Care Research Group.
• From the Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine (M.E.P., S.J.H.), and the Department of Emergency Medicine (M.E.P., B.E.D.), Hennepin County Medical Center, Minneapolis; the Department of Emergency Medicine (S.A.T.) and the Division of Pulmonary, Critical Care, and Sleep Medicine (I.S.D., T.G.), Denver Health Medical Center, Denver, and the Department of Emergency Medicine (S.A.T., D.R.-A., J.J.B., A.A.G.) and the Department of Medicine, Division of Pulmonary and Critical Care Medicine (I.S.D.), University of Colorado School of Medicine, Aurora; the Department of Medicine, Division of Pulmonary and Critical Care Medicine (K.P.S., T.W.R., J.D.C., M.W.S.), the Departments of Anesthesiology (J.P.W., C.G.H.), Emergency Medicine (B.D.L., W.H.S.), and Biostatistics (B.I., L.W.), and the Vanderbilt Institute for Clinical and Translational Research (J.P.R., K.N.W., W.H.S., T.W.R., M.W.S.), Vanderbilt University Medical Center, Nashville; the Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine (D.W.R., M.R.W., S.G., D.B.P.), and the Department of Emergency Medicine (M.R.W.), University of Alabama at Birmingham Heersink School of Medicine, and the Pulmonary Section, Birmingham Veterans Affairs Medical Center (D.W.R.) - both in Birmingham; the Department of Anesthesiology, Section on Critical Care (J.P.G.), and the Department of Emergency Medicine (J.P.G., J.K.G.), Atrium Health Wake Forest Baptist, and the Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest School of Medicine (K.W.G., J.A.P.), Winston-Salem, and the Department of Anesthesiology, Duke University School of Medicine, Durham (V.K., J.T.H.) - all in North Carolina; the Departments of Emergency Medicine (A.J.L., S.H.M.) and Anesthesiology and Critical Care Medicine (C.R.B., A.J.), University of Washington Harborview Medical Center, Seattle; the Department of Medicine, Division of Pulmonary Disease, Critical Care, and Sleep Medicine, Baylor Scott and White Health, Temple (S.A.G., H.D.W.), and the U.S. Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston (S.G.S.), and the 59th Medical Wing, U.S. Air Force, Fort Sam Houston (B.J.L.), San Antonio - all in Texas; the Department of Pulmonary and Critical Care Medicine, Ochsner Health (D.J.V., A.E.), and University Medical Center New Orleans and the Department of Medicine, Section of Pulmonary, Critical Care Medicine, and Allergy and Immunology, Louisiana State University School of Medicine (D.R.J.) - all in New Orleans; and the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston (A.D., N.I.S.).
• N. Engl. J. Med. 2023 Aug 3; 389 (5): 418429418-429.

BackgroundWhether video laryngoscopy as compared with direct laryngoscopy increases the likelihood of successful tracheal intubation on the first attempt among critically ill adults is uncertain.MethodsIn a multicenter, randomized trial conducted at 17 emergency departments and intensive care units (ICUs), we randomly assigned critically ill adults undergoing tracheal intubation to the video-laryngoscope group or the direct-laryngoscope group. The primary outcome was successful intubation on the first attempt. The secondary outcome was the occurrence of severe complications during intubation; severe complications were defined as severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death.ResultsThe trial was stopped for efficacy at the time of the single preplanned interim analysis. Among 1417 patients who were included in the final analysis (91.5% of whom underwent intubation that was performed by an emergency medicine resident or a critical care fellow), successful intubation on the first attempt occurred in 600 of the 705 patients (85.1%) in the video-laryngoscope group and in 504 of the 712 patients (70.8%) in the direct-laryngoscope group (absolute risk difference, 14.3 percentage points; 95% confidence interval [CI], 9.9 to 18.7; P<0.001). A total of 151 patients (21.4%) in the video-laryngoscope group and 149 patients (20.9%) in the direct-laryngoscope group had a severe complication during intubation (absolute risk difference, 0.5 percentage points; 95% CI, -3.9 to 4.9). Safety outcomes, including esophageal intubation, injury to the teeth, and aspiration, were similar in the two groups.ConclusionsAmong critically ill adults undergoing tracheal intubation in an emergency department or ICU, the use of a video laryngoscope resulted in a higher incidence of successful intubation on the first attempt than the use of a direct laryngoscope. (Funded by the U.S. Department of Defense; DEVICE ClinicalTrials.gov number, NCT05239195.).Copyright © 2023 Massachusetts Medical Society.

19 keywords...

hide…