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

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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.

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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

    Article  PubMed  Google Scholar 

  2. Asai T (2012) Videolaryngoscopes: do they truly have roles in difficult airways? Anesthesiology 116:515–517. doi:10.1097/ALN.0b013e318246e866

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    PubMed  Google Scholar 

  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

    PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  16. Calder I, Picard J, Chapman M et al (2003) Mouth opening: a new angle. Anesthesiology 99:799–801

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  19. Cormack RS, Lehane J (1984) Difficult tracheal intubation in obstetrics. Anaesthesia 39:1105–1111

    Article  PubMed  CAS  Google Scholar 

  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

    PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

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

Conflicts of interest

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

Author information

Authors and Affiliations

  1. Intensive Care and Anesthesiology Department, Saint Eloi Hospital, University of Montpellier, Montpellier, France

    Audrey De Jong, Noémie Clavieras, Matthieu Conseil, Yannael Coisel, Pierre-Henri Moury, Yvan Pouzeratte, Moussa Cisse, Fouad Belafia, Boris Jung, Gérald Chanques & Samir Jaber

  2. Unité U1046 de l’Institut National de la Santé et de la Recherche Médicale (INSERM), University of Montpellier, Montpellier, France

    Boris Jung, Gérald Chanques & Samir Jaber

  3. Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 729 MISTEA, Montpellier, France

    Nicolas Molinari

  4. Intensive Care Unit, Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, 80 avenue Augustin Fliche, 34295, Montpellier CEDEX 5, France

    Samir Jaber

Authors
  1. Audrey De Jong
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  2. Noémie Clavieras
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  3. Matthieu Conseil
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  4. Yannael Coisel
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  5. Pierre-Henri Moury
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  6. Yvan Pouzeratte
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  7. Moussa Cisse
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  8. Fouad Belafia
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  9. Boris Jung
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  10. Gérald Chanques
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  11. Nicolas Molinari
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  12. Samir Jaber
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Corresponding author

Correspondence to Samir Jaber.

Additional information

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.

ClinicalTrials.gov 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). https://doi.org/10.1007/s00134-013-3099-1

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  • DOI: https://doi.org/10.1007/s00134-013-3099-1

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