Effect of Laryngoscope Blade Size on First Pass Success of Tracheal Intubation in Critically Ill Adults

Autor: Kevin R. Landefeld, MD, Seiji Koike, MAS, Ran Ran, MD, Matthew W. Semler, MD, MSc, Christopher Barnes, MD, Susan B. Stempek, PA-C, MMSc, David R. Janz, MD, MSc, Todd W. Rice, MD, MSc, Derek W. Russell, MD, Wesley H. Self, MD, MPH, Derek Vonderhaar, MD, Jason R. West, MD, Jonathan D. Casey, MD, MSc, Akram Khan, MD, for the Pragmatic Critical Care Research Group, Adit A. Ginde, Sheetal Gandotra, Brian E. Driver, Matthew E. Prekker, Stacy Trent, David R. Janz, Derek W. Russell, Todd W. Rice, Wesley H. Self, Kevin Gibbs
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Critical Care Explorations, Vol 5, Iss 3, p e0855 (2023)
Druh dokumentu: article
ISSN: 2639-8028
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DOI: 10.1097/CCE.0000000000000855
Popis: OBJECTIVES:. Tracheal intubation (TI) is a common procedure in critical care, often performed with a Macintosh curved blade used for direct laryngoscopy (DL). Minimal evidence informs the choice between Macintosh blade sizes during TI. We hypothesized that Macintosh 4 blade would have higher first-attempt success than Macintosh 3 blade during DL. DESIGN:. Retrospective analysis using a propensity score and inverse probability weighting of data from six prior multicenter randomized trials. SETTING AND PARTICIPANTS:. Adult patients who underwent nonelective TI at participating emergency departments and ICUs. We compared the first-pass success of TI with DL in subjects intubated with a size 4 Macintosh blade on the first TI attempt to subjects with a size 3 Macintosh blade on the first TI attempt. MAIN RESULTS:. Among 979 subjects, 592 (60.5%) had TI using DL with a Macintosh blade, of whom 362 (37%) were intubated with a size 4 blade and 222 (22.7%) with a size 3 blade. We used inverse probability weighting with a propensity score for analyzing data. We found that patients intubated with a size 4 blade had a worse (higher) Cormack-Lehane grade of glottic view than patients intubated with a size 3 blade (adjusted odds ratio [aOR], 1.458; 95% CI, 1.064–2.003; p = 0.02). Patients intubated with a size 4 blade had a lower first pass success than those with a size 3 blade (71.1% vs 81.2%; aOR, 0.566; 95% CI, 0.372–0.850; p = 0.01). CONCLUSIONS AND RELEVANCE:. In critically ill adults undergoing TI using DL with a Macintosh blade, patients intubated using a size 4 blade on first attempt had a worse glottic view and a lower first pass success than patients intubated with a size 3 Macintosh blade. Further prospective studies are needed to examine the optimal approach to selecting laryngoscope blade size during TI of critically ill adults.
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