title: Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before-after comparative study.
abstract: OBJECTIVE
  Airway management in intensive care unit (ICU) patients is challenging. The main objective of this study was to compare the incidence of difficult laryngoscopy and/or difficult intubation between a combo videolaryngoscope and the standard Macintosh laryngoscope in critically ill patients.
  
  
  METHODS
  In the context of the implementation of a quality-improvement process for airway management, we performed a prospective interventional monocenter before-after study which evaluated a new combo videolaryngoscope. The primary outcome was the incidence of difficult laryngoscopy (defined by Cormack grade 3-4) and/or difficult intubation (more than two attempts). The secondary outcomes were the severe life-threatening complications related to intubation in ICU and the rate of difficult intubation in cases of predicted difficult intubation evaluated by a specific score (MACOCHA score ≥3).
  
  
  RESULTS
  Two hundred and ten non-selected consecutive intubation procedures were included, 140 in the standard laryngoscope group and 70 in the combo videolaryngoscope group. The incidence of difficult laryngoscopy and/or difficult intubation was 16 % in the laryngoscope group vs. 4 % in the combo videolaryngoscope group (p = 0.01). The severe life-threatening complications related to intubation did not differ between groups (16 vs. 14 %, p = 0.79). Among the 32 patients with a MACOCHA score ≥3, there were significantly more patients with difficult intubation in the standard laryngoscope group in comparison to the combo videolaryngoscope group [12/23 (57 %) vs. 0/9 (0 %), p < 0.01].
  
  
  CONCLUSIONS
  The systematic use of a combo videolaryngoscope in ICU was associated with a decreased incidence of difficult laryngoscopy and/or difficult intubation.
authors.affiliation: Intensive Care and Anesthesiology Department, Saint Eloi Hospital, University of Montpellier, Montpellier, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: De Jong
authors.forename: Noémie
authors.initials: N
authors.lastname: Clavieras
authors.forename: Matthieu
authors.initials: M
authors.lastname: Conseil
authors.forename: Yannael
authors.initials: Y
authors.lastname: Coisel
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Moury
authors.forename: Yvan
authors.initials: Y
authors.lastname: Pouzeratte
authors.forename: Moussa
authors.initials: M
authors.lastname: Cisse
authors.forename: Fouad
authors.initials: F
authors.lastname: Belafia
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.forename: Gérald
authors.initials: G
authors.lastname: Chanques
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014741:Video Recording
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