Log in | Register

Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before–after comparative study

Audrey De Jong| Noémie Clavieras| Matthieu Conseil| Yannael Coisel| Pierre-Henri Moury| Yvan Pouzeratte| Moussa Cisse| Fouad Belafia| Boris Jung| Gérald Chanques| Nicolas Molinari| Samir Jaber
Original
Volume 39, Issue 12 / December , 2013

Pages 2144 - 2152

Abstract

Purpose

Airway management in intensive care unit (ICU) patients is challenging. The main objective of this study was to compare the incidence of difficult laryngoscopy and/or difficult intubation between a combo videolaryngoscope and the standard Macintosh laryngoscope in critically ill patients.

Methods

In the context of the implementation of a quality-improvement process for airway management, we performed a prospective interventional monocenter before–after study which evaluated a new combo videolaryngoscope. The primary outcome was the incidence of difficult laryngoscopy (defined by Cormack grade 3–4) and/or difficult intubation (more than two attempts). The secondary outcomes were the severe life-threatening complications related to intubation in ICU and the rate of difficult intubation in cases of predicted difficult intubation evaluated by a specific score (MACOCHA score ≥3).

Results

Two hundred and ten non-selected consecutive intubation procedures were included, 140 in the standard laryngoscope group and 70 in the combo videolaryngoscope group. The incidence of difficult laryngoscopy and/or difficult intubation was 16 % in the laryngoscope group vs. 4 % in the combo videolaryngoscope group (p = 0.01). The severe life-threatening complications related to intubation did not differ between groups (16 vs. 14 %, p = 0.79). Among the 32 patients with a MACOCHA score ≥3, there were significantly more patients with difficult intubation in the standard laryngoscope group in comparison to the combo videolaryngoscope group [12/23 (57 %) vs. 0/9 (0 %), p < 0.01].

Conclusions

The systematic use of a combo videolaryngoscope in ICU was associated with a decreased incidence of difficult laryngoscopy and/or difficult intubation.

Keywords

References

  1. De Jong A, Molinari N, Terzi N, Mongardon N, Arnal J-M, Guitton C, Allaouchiche B, Paugam-Burtz C, Constantin J-M, Lefrant J-Y, Leone M, Papazian L, Asehnoune K, Maziers N, Azoulay E, Pradel G, Jung B, Jaber S (2013) Early identification of patients at risk for difficult intubation in ICU: development and validation of the MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med 187:832–839. doi:10.1164/rccm.201210-1851OC
    • View reference on PubMed
    • View reference on publisher's website
  2. Asai T (2012) Videolaryngoscopes: do they truly have roles in difficult airways? Anesthesiology 116:515–517. doi:10.1097/ALN.0b013e318246e866
    • View reference on PubMed
    • View reference on publisher's website
  3. Aziz MF, Healy D, Kheterpal S et al (2011) Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology 114:34–41. doi:10.1097/ALN.0b013e3182023eb7
    • View reference on PubMed
    • View reference on publisher's website
  4. Aziz MF, Dillman D, Fu R, Brambrink AM (2012) Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology 116:629–636. doi:10.1097/ALN.0b013e318246ea34
    • View reference on PubMed
    • View reference on publisher's website
  5. Cook T, Behringer EC, Benger J (2012) Airway management outside the operating room: hazardous and incompletely studied. Curr Opin Anaesthesiol 25:461–469. doi:10.1097/ACO.0b013e32835528b1
    • View reference on PubMed
    • View reference on publisher's website
  6. Noppens RR, Geimer S, Eisel N et al (2012) Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: a prospective, comparative study in the ICU. Crit Care 16:R103. doi:10.1186/cc11384
    • View reference on PubMed
    • View reference on publisher's website
  7. Kory P, Guevarra K, Mathew JP et al (2013) The impact of video laryngoscopy use during urgent endotracheal intubation in the critically ill. Anesth Analg. doi:10.1213/ANE.0b013e3182917f2a
    • View reference on PubMed
  8. Lakticova V, Koenig SJ, Narasimhan M, Mayo PH (2013) Video laryngoscopy is associated with increased first pass success and decreased rate of esophageal intubations during urgent endotracheal intubation in a medical intensive care unit when compared to direct laryngoscopy. J Intensive Care Med. doi:10.1177/0885066613492641
    • View reference on PubMed
  9. Jaber S, Jung B, Corne P et al (2010) An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med 36:248–255. doi:10.1007/s00134-009-1717-8
  10. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on PubMed
    • View reference on publisher's website
  11. Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-Related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710
  12. Simpson GD, Ross MJ, McKeown DW, Ray DC (2012) Tracheal intubation in the critically ill: a multi-centre national study of practice and complications. Br J Anaesth 108:792–799. doi:10.1093/bja/aer504
    • View reference on PubMed
    • View reference on publisher's website
  13. Singhal V, Sharma M, Prabhakar H et al (2009) Effect of posture on mouth opening and modified Mallampati classification for airway assessment. J Anesth 23:463–465. doi:10.1007/s00540-009-0761-4
    • View reference on PubMed
    • View reference on publisher's website
  14. Tham EJ, Gildersleve CD, Sanders LD et al (1992) Effects of posture, phonation and observer on Mallampati classification. Br J Anaesth 68:32–38
    • View reference on PubMed
    • View reference on publisher's website
  15. Lewis M, Keramati S, Benumof JL, Berry CC (1994) What is the best way to determine oropharyngeal classification and mandibular space length to predict difficult laryngoscopy? Anesthesiology 81:69–75
    • View reference on PubMed
    • View reference on publisher's website
  16. Calder I, Picard J, Chapman M et al (2003) Mouth opening: a new angle. Anesthesiology 99:799–801
    • View reference on PubMed
    • View reference on publisher's website
  17. Gonzalez H, Minville V, Delanoue K, Mazerolles M, Concina D, Fourcade O (2008) The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg 106:1132–1136
    • View reference on PubMed
    • View reference on publisher's website
  18. Apfelbaum JL, Hagberg CA, Caplan RA et al (2013) Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 118:251–270. doi:10.1097/ALN.0b013e31827773b2
    • View reference on PubMed
    • View reference on publisher's website
  19. Cormack RS, Lehane J (1984) Difficult tracheal intubation in obstetrics. Anaesthesia 39:1105–1111
    • View reference on PubMed
    • View reference on publisher's website
  20. Ayoub C, Baraka A, el-Khatib M et al (2000) A new cut-off point of thyromental distance for prediction of difficult airway. Middle East J Anesthesiol 15:619–633
    • View reference on PubMed
  21. Jaber S, Amraoui J, Lefrant J-Y et al (2006) Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med 34:2355–2361. doi:10.1097/01.CCM.0000233879.58720.87
    • View reference on PubMed
    • View reference on publisher's website
  22. Heuer JF, Barwing TA, Barwing J et al (2012) Incidence of difficult intubation in intensive care patients: analysis of contributing factors. Anaesth Intensive Care 40:120–127
    • View reference on PubMed
    • View reference on publisher's website
  23. Griesdale DEG, Bosma TL, Kurth T et al (2008) Complications of endotracheal intubation in the critically ill. Intensive Care Med 34:1835–1842. doi:10.1007/s00134-008-1205-6
  24. Baillard C, Fosse J-P, Sebbane M et al (2006) Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med 174:171–177. doi:10.1164/rccm.200509-1507OC
    • View reference on PubMed
    • View reference on publisher's website
  25. Cooper RM (2010) Reducing the risks associated with videolaryngoscopy. Anesth Analg 111:244; author reply 244. doi:10.1213/ANE.0b013e3181dd8b4f
  26. Cavus E, Kieckhaefer J, Doerges V et al (2010) The C-MAC videolaryngoscope: first experiences with a new device for videolaryngoscopy-guided intubation. Anesth Analg 110:473–477. doi:10.1213/ANE.0b013e3181c5bce5
    • View reference on PubMed
    • View reference on publisher's website
  27. Ng I, Hill AL, Williams DL et al (2012) Randomized controlled trial comparing the McGrath videolaryngoscope with the C-MAC videolaryngoscope in intubating adult patients with potential difficult airways. Br J Anaesth 109:439–443. doi:10.1093/bja/aes145
    • View reference on PubMed
    • View reference on publisher's website
  28. Levy MM, Dellinger RP, Townsend SR et al (2010) The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med 36:222–231. doi:10.1007/s00134-009-1738-3
  29. Ananda-Rajah MR, McBryde ES, Buising KL et al (2010) The role of general quality improvement measures in decreasing the burden of endemic MRSA in a medical-surgical intensive care unit. Intensive Care Med 36:1890–1898. doi:10.1007/s00134-010-2019-x
  30. Misset B, Timsit J-F, Dumay M-F et al (2004) A continuous quality-improvement program reduces nosocomial infection rates in the ICU. Intensive Care Med 30:395–400. doi:10.1007/s00134-003-2096-1
  31. Amathieu R, Combes X, Abdi W et al (2011) An algorithm for difficult airway management, modified for modern optical devices (Airtraq laryngoscope; LMA CTrach™): a 2-year prospective validation in patients for elective abdominal, gynecologic, and thyroid surgery. Anesthesiology 114:25–33. doi:10.1097/ALN.0b013e318201c44f
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement