• David R Janz, Matthew W Semler, Robert J Lentz, Daniel T Matthews, Tufik R Assad, Brett C Norman, Raj D Keriwala, Benjamin A Ferrell, Michael J Noto, Ciara M Shaver, Bradley W Richmond, Jeannette Zinggeler Berg, Todd W Rice, and Facilitating EndotracheaL intubation by Laryngoscopy technique and apneic Oxygenation Within the ICU Investigators and the Pragmatic Critical Care Research Group.
• 1Department of Medicine, Section of Pulmonary and Critical Care Medicine Louisiana State University School of Medicine, New Orleans, LA. 2Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
• Crit. Care Med. 2016 Nov 1; 44 (11): 1980-1987.

ObjectiveTo evaluate the effect of video laryngoscopy on the rate of endotracheal intubation on first laryngoscopy attempt among critically ill adults.DesignA randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows.SettingMedical ICU in a tertiary, academic medical center.PatientsCritically ill patients 18 years old or older.InterventionsPatients were randomized 1:1 to video or direct laryngoscopy for the first attempt at endotracheal intubation.Measurements And Main ResultsPatients 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.ConclusionsIn critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications.

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