Endotracheal Intubation, Intubation Complication, Intubation; Difficult or Failed
Conditions
Keywords
Intubation, Operative Room, Macintosh, Direct Laryngoscopy, Video Laryngoscopy, Complications
Brief summary
Endotracheal intubation is a frequent procedure in the operating room but optimal Macintosh blade size remains unknown to date.
Detailed description
Endotracheal intubation is an extremely frequent procedure in the operating room, in intensive care units and in emergency medicine (in- or out-of-hospital). Apart from special cases of foreseen difficult programmed intubation, direct laryngoscopy remains the most frequently used technique. It requires the use of a handle (short or long), which serves as a light source on which is adapted a Macintosh curved blade, metallic or plastic, single or multiple use. The choice of blade size is based on the experience of the physician. Most often, in adult settings, size 3 or 4 blades are used. The very spartan literature on the subject and the current recommendations do not provide any information on the choice of blade size. Our team (and others) recently concluded that intubation first attempt rates in intensive care units or emergency settings were improved when using shorter Macintosh blade size No3 vs 4 (Godet et al. Intensive Care Medicine 2022 and Landefeld et al. Critical Care Explorations 2023). We therefore wish to evaluate these practices in terms of success of the first laryngoscopy, Cormack-Lehane and POGO (percentage of glottic opening visualized) scores, the need to use an alternative technique or a second operator in operative rooms. The results will be analyzed with regard as a function and experience of the person performing the laryngoscopy, as well as the setting (urgent or scheduled). These data are usually collected during the performance of an endotracheal intubation in a nationwide fashion in French operative rooms.
Interventions
DEVICEDirect laryngoscopy using Macintosh blade
Patients in operative room requiring direct laryngoscopy for endotracheal intubation
Sponsors
University Hospital, Clermont-Ferrand
Société Française d'Anesthésie-Réanimation (SFAR)
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients must be admitted in a participating operative room and require mechanical ventilation through an orotracheal tube. * Adult (age ≥ 18 years) * Subjects must be covered by public health insurance * Written informed consent from the patient or proxy (if present) before inclusion or once possible when patient has been included in a context of emergency.
Exclusion criteria
* Anticipated difficult intubation requiring videolaryngoscopy or other technic in first place * Nasotracheal intubation * Refusal of study participation or to pursue the study by the patient * Absence of coverage by the French statutory healthcare insurance system * Protected person
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients with successful first-pass orotracheal intubation | At intubation | The proportion of patients with successful first-pass orotracheal intubation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Severe complications related to intubation_hypoxemia | At intubation | Rate of severe hypoxemia defined by lowest oxygen saturation (SpO2) \< 90 % |
| Severe complications related to intubation_severe collapse | At intubation | Rate of cardiovascular collapse, defined as systolic blood pressure less than 80 mmHg systolic blood pressure less than 50 mmHg recorded at least once |
| Severe complications related to intubation_cardiac arrest | At intubation | Rate of cardiac arrest related to intubation |
| Severe complications related to intubation_death | At intubation | Rate of death related to intubation |
| Moderate complications related to intubation_difficult intubation | At intubation | Rate of difficult intubation |
| Moderate complications related to intubation_arrythmia | At intubation | Rate of severe ventricular or supraventricular arrhythmia requiring intervention |
| Moderate complications related to intubation_oesophageal intubation | At intubation | Rate of oesophageal intubation |
| Moderate complications related to intubation_agitation | At intubation | Rate of agitation |
| Moderate complications related to intubation_aspiration | At intubation | Rate of pulmonary aspiration |
| Moderate complications related to intubation_dental injuries | At intubation | Rate of dental injuries |
| Cormack Lehane | During laryngoscopy | Cormack-Lehane grade of glottic view |
| Percentage of Glottic Opening | During laryngoscopy | Percentage of Glottic Opening (POGO) grade of glottic view |
| Difficulty of intubation | During intubation | Rate of operator-assessed difficulty of intubation |
| Additional airway equipment | During intubation | Rate of need for additional airway equipment (video laryngoscope, bougie, stylet, fibroscope, cricothyrotomy) |
| Additional second operator | During intubation | Rate of need for a second operator |
Countries
France
Contacts
PRINCIPAL_INVESTIGATORThomas Godet, MD, PhD
Clermont-Ferrand University Hospitals
Outcome results
None listed