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

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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.


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).


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].


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

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The authors are grateful to Valérie Macioce, Statistic Department, La Colombière University Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, 34295, France for her English editing.

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The authors declare that they have no conflict of interest related to the subject of the study.

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Correspondence to Samir Jaber.

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Take-home message: A quality-improvement process for airway management in ICU implementing systematic use of a mixed videolaryngoscope decreased the incidence of difficult intubation and/or difficult laryngoscopy. Identifier: NCT01816217.

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De Jong, A., Clavieras, N., Conseil, M. et al. Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before–after comparative study. Intensive Care Med 39, 2144–2152 (2013).

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