Video laryngoscopy in infants facilitates orotracheal intubation in first attempt: Study
USA: The use of video laryngoscopy with a standard blade improves first-attempt success rate of orotracheal intubation and reduces complications, reveals a recent study in the journal Lancet.
Using direct laryngoscopy for orotracheal intubation in infants can be challenging. Annery G Garcia-Marcinkiewicz, The Children's Hospital of Philadelphia, Philadelphia, USA, and colleagues aimed to investigate whether video laryngoscopy with a standard blade done by anaesthesia clinicians helps in improving the first-attempt success rate of orotracheal intubation and reduces complications risk versus the direct laryngoscopy. The researchers hypothesized that the first-attempt success rate would be higher with video laryngoscopy than with direct laryngoscopy.
The researchers recruited infants without difficult airways abnormalities requiring orotracheal intubation in operating theatres at four quaternary children's hospitals in the USA and one in Australia. 564 infants were randomly assigned in the ratio 1:1 to receive either video laryngoscopy (n=282) or direct laryngoscopy (n=282). The mean age of infants was 5·5 months.
274 infants in the video laryngoscopy group and 278 infants in the direct laryngoscopy group were included in the mITT analysis.
The primary outcome was the proportion of infants with a successful first attempt at orotracheal intubation.
Key findings of the study include:
- In the video laryngoscopy group, 254 (93%) infants were successfully intubated on the first attempt compared with 244 (88%) in the direct laryngoscopy group (adjusted absolute risk difference 5·5%).
- Severe complications occurred in four (2%) infants in the video laryngoscopy group compared with 15 (5%) in the direct laryngoscopy group (–3·7%).
- Fewer oesophageal intubations occurred in the video laryngoscopy group (n=1 [<1%]) compared with in the direct laryngoscopy group (n=7 [3%]; –2·3).
"Among anaesthetised infants, using video laryngoscopy with a standard blade improves the first-attempt success rate and reduces complications," concluded the authors.
"First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial," is published in the journal Lancet.
DOI: https://doi.org/10.1016/S0140-6736(20)32532-0
