title: Video Laryngoscopy Improves Odds of First-Attempt Success at Intubation in the Intensive Care Unit. A Propensity-matched Analysis.
abstract: BACKGROUND
  Urgent tracheal intubation is performed frequently in intensive care units and incurs higher risk than when intubation is performed under more controlled circumstances. Video laryngoscopy may improve the chances of successful tracheal intubation on the first attempt; however, existing comparative data on outcomes are limited.
  
  
  OBJECTIVE
  To compare first-attempt success and complication rates during intubation when using video laryngoscopy compared with traditional direct laryngoscopy in a tertiary academic medical intensive care unit.
  
  
  METHODS
  We prospectively collected and analyzed data from a continuous quality improvement database of all intubations in one medical intensive care unit between January 1, 2012, and December 31, 2014. Propensity matching and multivariable logistic regression were used to reduce the risk of bias and control for confounding.
  
  
  RESULTS
  A total of 809 intubations took place over the study period. Of these, 673 (83.2%) were performed using video laryngoscopy and 136 (16.8%) using direct laryngoscopy. First-attempt success with video laryngoscopy was 80.4% (95% confidence interval [CI], 77.2-83.3%) compared with 65.4% (95% CI, 56.8-73.4%) for intubations performed with direct laryngoscopy (P < 0.001). In a propensity-matched analysis, the odds ratio for first-attempt success with video laryngoscopy versus direct laryngoscopy was 2.81 (95% CI, 2.27-3.59). The rate of arterial oxygen desaturation events during the first intubation attempt was significantly lower for video laryngoscopy than for direct laryngoscopy (18.3% vs. 25.9%; P = 0.04). The rate of esophageal intubation during any attempt was also significantly lower for video laryngoscopy (2.1% vs. 6.6%; P = 0.008).
  
  
  CONCLUSIONS
  Video laryngoscopy was associated with significantly improved odds of first-attempt success at tracheal intubation by nonanesthesiologists in a medical intensive care unit. Esophageal intubation and oxygen desaturation occurred less frequently with the use of video laryngoscopy. Randomized clinical trials are needed to confirm these findings.
authors.affiliation: 1 Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, and.|2 Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Hypes
authors.affiliation: 2 Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Uwe
authors.initials: U
authors.lastname: Stolz
authors.affiliation: 2 Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
authors.affiliation: 1 Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, and.|2 Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Joshi
authors.affiliation: 1 Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, and.
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Natt
authors.affiliation: 1 Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, and.
authors.forename: Josh
authors.initials: J
authors.lastname: Malo
authors.affiliation: 1 Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, and.
authors.forename: John W
authors.initials: JW
authors.lastname: Bloom
authors.affiliation: 1 Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, and.|2 Department of Emergency Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Jarrod M
authors.initials: JM
authors.lastname: Mosier
mesh_terms: D000368:Aged; D001130:Arizona; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards; D007828:Laryngoscopy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D058996:Quality Improvement; D062606:Tertiary Care Centers; D020535:Video-Assisted Surgery / Q000379:methods*
keywords: airway management; artificial respiration; intensive care units; intratracheal intubation; laryngoscopy