An assessment of critical care intubations requiring an airway introducer with the two existing endotracheal tip designs : the INTUBATE study

To determine whether intubations using an Antero-Posterior (AP) bevel design with the Genesis or Parkerflex endotracheal tube compared to left-facing bevel of the Portex endotracheal tube results in significantly fewer observed difficulties in passing the ETT through the cords. critical care intubations are most frequently done using a airway introducer ("bougie") to intubate the trachea initially and then passing an endotracheal tube over the bougie into the airway. The design of the tip may influence the ease of passage and influence the time and the complications that are recognised. These intubations in critical care are done by emergency, intensive care and anaesthetic doctors in various stages of training. in a fully monitored hospital environment, supported by senior doctors and nurses. There are on average 5 critical care intubations in either ICU or Emergency departments per week. the trial is approved for a waiver of consent prior to randomisation, so there will be minimal or no delay before intubation, but later requires a consent to continue to collect data. The time taken for each intubation is typically 1-2 minutes for most intubations. The video-laryngosope used are either a C-MAC or a Glidescope with a blade of the clinicians choice and video recording, and will be mandated for all critical care intubations in our institution. A videolaryngoscope is a piece of equipment that has a small camera on the tip of a laryngoscope with a corresponding screen at the bedside to view the image. a laryngoscope is a handle with a curved "blade" that goes over the tongue to reach near the voicebox to allow a clear view of the voicebox (A.k.a. the larynx) so that a breathing tube or similar adjunct can be placed accurately. Fidelity or adherence to the protocol will be ensured by an Intubation Checklist which is performed involving all staff, and used for all critical care intubations and specifically updated for this study. If initial technique fails - the operators can use whatever device or adjunct or technique that will maximise their success - if the tube selection is changed it will be regarded as a response to one of the outcome questions of " did the tube size or type have to be changed". if the patient is intubated again on a separate occasion ( separate in time or place ) the patient may be included as a new event and randomised again - if there is appropriate time to randomise and the operators are agreeable to inclusion in the study. they would be excluded from randomisation if the operator decides beforehand that they require a different technique or opinion.