title: The impact of video laryngoscopy use during urgent endotracheal intubation in the critically ill.
abstract: BACKGROUND
  The video laryngoscope (VL) has been shown to improve laryngoscopic views and first-attempt success rates in elective operating room and simulated tracheal intubations compared with the direct laryngoscope (DL). However, there are limited data on the effectiveness of the VL compared with the DL in urgent endotracheal intubations (UEIs) in the critically ill. We assessed the effectiveness of using a VL as the primary intubating device during UEI in critically ill patients when performed by less experienced operators.
  
  
  METHODS
  We compared success rates of UEIs performed by Pulmonary and Critical Care Medicine (PCCM) fellows in the medical intensive care unit and medical or surgical wards. A cohort of PCCM fellows using GlideScope VL as the primary intubating device was compared with a historical cohort of PCCM fellows using a traditional Macintosh or Miller blade DL. The primary measured outcome was first-attempt intubation success rate. Secondary outcomes included total number of attempts required for successful tracheal intubation, rate of esophageal intubation, need for supervising attending intervention, duration of intubation sequence, and incidence of hypoxemia and hypotension.
  
  
  RESULTS
  There were 138 UEIs, with 78 using a VL and 50 using a DL as the primary intubating device. The rate of first-attempt success was superior with the VL as compared with the DL (91% vs 68%, P < 0.01). The rate of intubations requiring ≥3 attempts (4% vs 20%, P < 0.01), unintended esophageal intubations (0% vs 14%, P < 0.01), and the average number of attempts required for successful tracheal intubation (1.2 ± 0.56 vs 1.7 ± 1.1, P < 0.01) all improved significantly with use of the VL compared with the DL.
  
  
  CONCLUSIONS
  UEI using a VL as the primary device improved intubation success and decreased complications compared with a DL when PCCM fellows were the primary operators. These data suggest that the VL should be used as the primary device when urgent intubations are performed by less experienced operators.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, 7th Floor Dazian Bldg., 16th St. and First Ave., New York, NY 10003, USA. pkory@chpnet.org
authors.forename: Pierre
authors.initials: P
authors.lastname: Kory
authors.forename: Keith
authors.initials: K
authors.lastname: Guevarra
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Mathew
authors.forename: Abhijith
authors.initials: A
authors.lastname: Hegde
authors.forename: Paul H
authors.initials: PH
authors.lastname: Mayo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D007828:Laryngoscopy / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods* / Q000592:standards