PURPOSE: The risks of morbidity and mortality from emergent endotracheal intubation (EEI) increase with each failed attempt. The GlideScope(r)Video Laryngocope (GVL(r), Verathon Inc, Bothell, WA) was developed to assist endotracheal intubation by facilitating direct visualization of the vocal cords. Prior studies in elective surgery patients have shown increased first pass success rates and improved laryngoscopic views when a GVL(r) was used. We assessed the safety and efficacy of using a GVL(r) during EEI of critically ill patients.
METHODS: Data on EEI performed by Pulmonary/Critical Care Medicine (PCCM) fellows were collected prospectively using a standardized data collection instrument, done as per protocol for de-briefing purposes since 2006. Data on attempts, duration, and need for advanced intervention were recorded. EEI's from two time periods were extracted from the EEI database for comparison. The GVL(r) group consisted of consecutive EEI performed from 2/10 - 5/10 when a GVL(r) was used as the primary device. The standard laryngoscopy (SL) group consisted of consecutive EEI performed from 2/06 - 5/06 when a SL was used as primary device. All EEI performed by PCCM fellows during these time periods were done using an identical, validated, checklist/combined teams approach.
RESULTS: 95% of the GVL(r) group vs. 65% of the SL group were successful on the first pass (p<.01). Average number of attempts between the GVL(r) and SL was 1.04 and 1.70 respectively (p<.01). 0% of GVL(r) vs. 20% of SL required > 2 attempts (p<.01). 5% of GVL(r) vs. 13% of SL required advanced intervention (p=0.25). Average time from sedative administration to tube placement was 3.7 minutes in the GVL(r) group vs. 13.2 minutes in the SL group (p<0.001).
CONCLUSION: EEI using a GVL(r) leads to higher first pass success rates, shorter time, and less need for advanced intervention when compared to a SL.
CLINICAL IMPLICATIONS: GlideScope(r)Video Laryngoscope should be used in place of SL for EEI performed by PCCM fellows to ensure maximal patient safety.
DISCLOSURE: Keith Guevarra, No Financial Disclosure Information; No Product/Research Disclosure Information