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Endotracheal intubation using the C-MAC？ video laryngoscope or the Macintosh laryngoscope A prospective, comparative study in the ICU.doc

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Endotracheal intubation using the C-MAC？ video laryngoscope or the Macintosh laryngoscope A prospective, comparative study in the ICU

Noppensetal.CriticalCare2012,16:R103 /content/16/3/R103 RESEARCH OpenAccess EndotrachealintubationusingtheC-MAC?video laryngoscopeortheMacintoshlaryngoscope:A prospective,comparativestudyintheICU RuedigerRNoppens?,StephanieGeimer,NicoleEisel,MatthiasDavidandTimPiepho*? Abstract Introduction:EndotrachealintubationintheICUisachallengingprocedureandisfrequentlyassociatedwithlife- threateningcomplications.TheaimofthisstudywastoinvestigatetheeffectoftheC-MAC? videolaryngoscope onlaryngealviewandintubationsuccesscomparedwithdirectlaryngoscopy. Methods:Inasingle-center,prospective,comparativebefore-afterstudyinananesthetist-leadsurgicalICUofa tertiaryuniversityhospital,predictorsofpotentiallydifficulttrachealintubation,numberofintubationattempts, successrateandglotticviewwereevaluatedduringa2-yearstudyperiod(firstyear,Macintoshlaryngoscopy(ML); secondyear,C-MAC?). Results:Atotalof274criticallyillpatientsrequiringendotrachealintubationwereincluded;113intubationsusing MLand117intubationsusingtheC-MAC? wereassessed.Inpatientswithatleastonepredictorfordifficult intubation,theC-MAC? resultedinmoresuccessfulintubationsonfirstattemptcomparedwithML(34/43,79%vs. 21/38,55%;P=0.03).ThevisualizationoftheglottiswithMLusingCormackandLehane(CL)gradingwasmore frequentlyratedasdifficult(20%,CLgrade3and4)comparedwiththeC-MAC? (7%,CLgrade3and4)(P 0.0001). Conclusion:UseoftheC-MAC? videolaryngoscopeimprovedlaryngealimagingandimprovedtheintubating successrateonthefirstattemptinpatientswithpredictorsfordifficultintubationintheICUsetting.Video laryngoscopyseemstobeausefultoolintheICUwherepotentiallydifficultendotrachealintubationsregularly occur. Introduction increasetheriskoflife-threatening complications,such Airwaymanagementforcriticallyillpatientsinlocations asseverehypoxia,esophagealintubation,aspirationand other than the operating room is challenging and fre- cardiacarrest[2,5,6].Thisknowledgesuggeststhatopti- quently associated with life-threatening complicat