LAUSR

Learning Objectives: Endotracheal intubation (ETI) techniques have been evolving. While direct laryngoscopy (DL) remains the standard of care, video laryngoscopy (VL) has emerged as a commonly used method for ETI. Previous studies have questioned the complication risks associated with VL. At our metropolitan teaching hospital we have adopted both techniques for ETI. The objective of this study was to prospectively compare complications of DL vs VL for ETI. Methods: A prospective open randomized control trial evaluating complications of DL vs VL in patients requiring ETI in the ICU. Patients were randomized to the type of laryngoscopy performed. In the case of DL, the choice of Mac or Miller blade was discretionary. VL was performed with a GlidescopeTM. ETI was performed by both critical care physicians and fellows. Age, gender, BMI, time to ETI (TTI), number of attempts, need for vasopressors (VP), SOFA scores, and Cormack Lehane grades (CLG) were collected. Recorded complications included: crossover from randomized device, arterial systolic blood pressure <90 mmHg, aspiration, bleeding, cardiac arrest, SpO2 <80%, esophageal intubation, and death during ETI. Patients were excluded if the provider did not have time to randomize or requested a specific device. Sample size calculation was based on an alpha value of <0.05 and powered to 0.8 to detect a 5% difference in complications based on a 20% complication rate described in the literature. Results: ETI was performed with DL (n=185) and VL (n=212). Fellows performed 87% of ETI. There was no statistically significant difference for age (66 ± 17 vs 69 ± 15, p=0.11), gender (female, 42% vs 42%, p=0.56), BMI (29.7 ± 9.2 vs 30.6 ± 8.4, p=0.32), TTI in minutes (2.02 ± 0.2 vs 2 ± 0.2, p=0.55), number of attempts (1.26 ± 0.64 vs 1.18±,p=0.79) or VP (15% vs 16%, p=0.17). There were more crossovers in DL vs VL (12 vs 4, p=0.02), SOFA scores were lower in the DL group (5.13 + 2.8 vs 5.72 + 2.89, p=0.041) and VL had lower CLG (1.4 ± 0.63 vs 1.88 ± 0.89, p=0.001). Overall, complications of DL and VL were not significantly different (57/212 27% vs 42/185 23% p=0.289). Conclusions: Our study showed no statistically significant difference in overall complications between DL vs VL for ETI. The significance of crossovers between the two groups is potentially explained by differences in CLG.