Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized...

Area of Science:

• Anesthesiology
• Airway Management
• Surgical Procedures

Background:

• Direct laryngoscopy is the standard for endotracheal intubation in operating rooms.
• Video laryngoscopy offers improved airway visualization, but its impact on intubation attempts in surgical settings is not well-established.

Purpose of the Study:

• To compare the number of endotracheal intubation attempts using video laryngoscopy versus direct laryngoscopy in adult surgical patients.

Main Methods:

• A cluster randomized crossover trial involving adult patients undergoing cardiac, thoracic, or vascular surgery requiring endotracheal intubation.
• Operating rooms were randomized weekly to use either hyperangulated video laryngoscopy or direct laryngoscopy for the initial intubation attempt.
• Intention-to-treat analysis was performed on data from 8429 surgical procedures.

Main Results:

• Fewer intubation attempts were needed with video laryngoscopy (1.7%) compared to direct laryngoscopy (7.6%).
• Intubation failure rates were significantly lower with video laryngoscopy (0.27%) versus direct laryngoscopy (4.0%).
• Airway and dental injury rates were similar between the two methods.

Conclusions:

• Hyperangulated video laryngoscopy reduces the number of endotracheal intubation attempts and intubation failures in surgical patients.
• Video laryngoscopy appears to be a more effective approach for endotracheal intubation in this patient population.
• Further research may support video laryngoscopy as a preferred method for surgical airway management.