Video laryngoscopy has a superior first pass success rate compared with direct laryngoscopy in the ICU


Video laryngoscopy is superior to direct laryngoscopy for emergency intubations in the ICU. A recent meta-analysis based on nine trials evaluated 2,133 ICU patients and concluded that video laryngoscopy (VL) has a higher first pass success rate compared to direct laryngoscopy (DL). The meta-analysis demonstrated that VL reduces the risk of difficult orotracheal intubation (OR=0.29), Cormack 3/4 grades (OR=0.26), and esophageal intubations (OR=0.14). Additionally, compared to DL, VL had a higher first pass success rate.

A second study out of Beth Israel Medical Center examined 153 consecutive patients who required urgent endotracheal intubation all performed by pulmonary and critical care fellows. Each patient was randomly assigned to receive either direct laryngoscopy or Glidescope video laryngoscopy. Results showed that 74% of the Glidescope VL intubations were successful on the first attempt. Conversely, only 40% of the direct laryngoscopy group had first-attempt success. Of the patients who had an unsuccessful direct laryngoscopy intubation, all of them then had successful Glidescope video laryngoscopy intubations. In all, compared to direct laryngoscopy, video laryngoscopy significantly increases the first-attempt success rate during critical endotracheal intubations. Of note in this study, very few patients received neuromuscular blockers for paralysis which likely explains the low overall first-pass success rates in either group.

Despite this data, I still firmly believe that physicians and advanced practice providers must learn how to properly perform direct laryngoscopy and traditional endotracheal intubation. This is a critical skill to learn and may be necessary if your institution lacks video laryngoscopy or when the video laryngoscope is broken.

De Jong A. et al. Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis. Intensive Care Med. 2014; 40: 629-639.
Silverberg MJ et al. Comparison of video laryngoscopy versus direct laryngoscopy during urgent endotracheal intubation: a randomized controlled trial.Crit Care Medicine. 2015; 43 (3): 636- 641.

Read all articles in Airway management, direct laryngoscopy, emergency procedures, Endotracheal Intubation, Featured Procedure, Glidescope Intubation, HPC Updates, Intubation, Procedure Blog of the Week, video laryngoscopy
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