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Effect of Laryngoscope Blade Size on First Pass Success of Tracheal Intubation in Critically Ill Adults
- Source :
- Critical Care Explorations, Vol 5, Iss 3, p e0855 (2023)
- Publication Year :
- 2023
- Publisher :
- Wolters Kluwer, 2023.
-
Abstract
- 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.
- Subjects :
- Medical emergencies. Critical care. Intensive care. First aid
RC86-88.9
Subjects
Details
- Language :
- English
- ISSN :
- 26398028 and 00000000
- Volume :
- 5
- Issue :
- 3
- Database :
- Directory of Open Access Journals
- Journal :
- Critical Care Explorations
- Publication Type :
- Academic Journal
- Accession number :
- edsdoj.27d5cda0bf9467bbd66d9c6940911fc
- Document Type :
- article
- Full Text :
- https://doi.org/10.1097/CCE.0000000000000855