title: Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults.
abstract: OBJECTIVE
  To evaluate the effect of video laryngoscopy on the rate of endotracheal intubation on first laryngoscopy attempt among critically ill adults.
  
  
  METHODS
  A randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows.
  
  
  METHODS
  Medical ICU in a tertiary, academic medical center.
  
  
  METHODS
  Critically ill patients 18 years old or older.
  
  
  METHODS
  Patients were randomized 1:1 to video or direct laryngoscopy for the first attempt at endotracheal intubation.
  
  
  RESULTS
  Patients 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.
  
  
  CONCLUSIONS
  In critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications.
authors.affiliation: 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.
authors.forename: David R
authors.initials: DR
authors.lastname: Janz
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Semler
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lentz
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Matthews
authors.forename: Tufik R
authors.initials: TR
authors.lastname: Assad
authors.forename: Brett C
authors.initials: BC
authors.lastname: Norman
authors.forename: Raj D
authors.initials: RD
authors.lastname: Keriwala
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Ferrell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Noto
authors.forename: Ciara M
authors.initials: CM
authors.lastname: Shaver
authors.forename: Bradley W
authors.initials: BW
authors.lastname: Richmond
authors.forename: Jeannette
authors.initials: J
authors.lastname: Zinggeler Berg
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013997:Time Factors; D014741:Video Recording
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen