The following is a summary of the article titled “Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults,” published in the August 2023 issue of Critical Care by Prekker et al.

Researchers conducted a retrospective study to determine whether video laryngoscopy improves first-attempt intubation in critically ill adults.

They worked a trial in 17 emergency departments and intensive care units (ICUs), assigning sick critical adults to video or direct laryngoscope groups for tracheal intubation. The primary focus was achieving successful first-attempt intubation. Severe complications like hypoxemia, hypotension, vasopressor use, cardiac arrest, and death were noted.

The results showed that the trial was terminated early due to efficacy after a single planned interim analysis. Out of 1,417 patients (91.5% intubated by emergency medicine residents or critical care fellows), initial success rates were 85.1% (600/705) in the video laryngoscopy group and 70.8% (504 / 712) in the direct laryngoscopy group (absolute risk difference, 14.3% with 95% CI, 9.9 to 18.7; P<0.001). Severe complications occurred in 21.4% (151 patients) of the video laryngoscopy group and 20.9% (149 patients) of the direct laryngoscopy group (absolute risk difference, 0.5 %; 95% CI, -3.9 to 4.9). Safety outcomes, including intubation, teeth, and aspiration, were similar in both groups.

They concluded that video laryngoscopy in critically ill adults intubated in emergency departments or ICUs led to more tremendous initial intubation success than direct laryngoscopy.

Source: nejm.org/doi/full/10.1056/NEJMoa2301601