Tracheal Intubation With Stylet Have High First Pass Intubation Success Rate
Tracheal intubation is one of the most commonly performed procedures in the intensive care unit (ICU). The current coronavirus disease 2019 (COVID-19) pandemic has further highlighted the importance of understanding the best approach to providing tracheal intubation for critically ill patients. A recent study suggests that the use of a stylet for tracheal intubation in critically ill adult patients resulted in significantly higher first-attempt intubation success than the use of tracheal tube alone. The research has been published in the journal Intensive Care Medicine on May 25, 2021.
The most widely used method for tracheal intubation in critically ill patients involves using an endotracheal tube alone. While intubation stylets have been used for decades in emergency airway management, the effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. Therefore, Dr Samir Jaber and his team hypothesized that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.
"The results of this study have the potential to change airway management practice in critically ill patients. Conventionally, a stylet is used with the tracheal tube when the first attempt at tracheal intubation fails," said Dr Sheila Nainan Myatra in an editorial comment.
The STYLETO trial was a multicentre randomized controlled trial, conducted in 32 intensive care units. The researchers included a total of 999 patients and randomly assigned them to the tracheal tube + stylet group(n=501)or tracheal tube alone group (n=498). The major outcome assessed was the proportion of patients with first-attempt intubation success. The researchers also evaluated the proportion of patients with complications and serious adverse events related to tracheal intubation.
Key findings of the study were:
- Upon analysis, the researchers found that first-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7).
- They noted that a total of 194 patients had tracheal intubation related complication in the tracheal tube + stylet group and 200 patients in the tracheal tube alone group (absolute risk difference, − 1.5).
- They also noted that the incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4).
The authors concluded, "Among critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success."
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