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Efficacy and adverse events profile of videolaryngoscopy in critically ill patients : subanalysis of the INTUBE study

Russotto, Vincenzo ; Lascarrou, Jean Baptiste ; Tassistro, Elena ; Parotto, Matteo ; Antolini, Laura ; Bauer, Philippe ; Szułdrzyński, Konstanty ; Camporota, Luigi ; Putensen, Christian and Pelosi, Paolo , et al. (2023) In British Journal of Anaesthesia 131(3). p.607-616
Abstract

Background: Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. Methods: This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and... (More)

Background: Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. Methods: This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy. Results: Of 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P=0.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P<0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05–1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95–1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60–1.02). Conclusions: In critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events. Clinical trial registration: NCT03616054.

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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adverse events, airway management, critical care, INTUBE study, tracheal intubation, videolaryngoscopy
in
British Journal of Anaesthesia
volume
131
issue
3
pages
10 pages
publisher
Elsevier
external identifiers
  • pmid:37208282
  • scopus:85159559533
ISSN
0007-0912
DOI
10.1016/j.bja.2023.04.022
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2023 British Journal of Anaesthesia
id
1f52dd46-edd4-4c83-8970-9ac594dc4490
date added to LUP
2024-05-09 23:14:31
date last changed
2024-05-24 01:10:24
@article{1f52dd46-edd4-4c83-8970-9ac594dc4490,
  abstract     = {{<p>Background: Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. Methods: This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy. Results: Of 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P=0.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P&lt;0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05–1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95–1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60–1.02). Conclusions: In critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events. Clinical trial registration: NCT03616054.</p>}},
  author       = {{Russotto, Vincenzo and Lascarrou, Jean Baptiste and Tassistro, Elena and Parotto, Matteo and Antolini, Laura and Bauer, Philippe and Szułdrzyński, Konstanty and Camporota, Luigi and Putensen, Christian and Pelosi, Paolo and Sorbello, Massimiliano and Higgs, Andy and Greif, Robert and Grasselli, Giacomo and Valsecchi, Maria G. and Fumagalli, Roberto and Foti, Giuseppe and Caironi, Pietro and Bellani, Giacomo and Laffey, John G. and Myatra, Sheila N.}},
  issn         = {{0007-0912}},
  keywords     = {{adverse events; airway management; critical care; INTUBE study; tracheal intubation; videolaryngoscopy}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{607--616}},
  publisher    = {{Elsevier}},
  series       = {{British Journal of Anaesthesia}},
  title        = {{Efficacy and adverse events profile of videolaryngoscopy in critically ill patients : subanalysis of the INTUBE study}},
  url          = {{http://dx.doi.org/10.1016/j.bja.2023.04.022}},
  doi          = {{10.1016/j.bja.2023.04.022}},
  volume       = {{131}},
  year         = {{2023}},
}