Ruediger R Noppens, Stephanie Geimer, Nicole Eisle, Matthias David, Tim Piepho Critical Care 2012, 16:R103 (13 June 2012)
Introduction: Endotracheal intubation in the intensive care unit (ICU) is a challenging procedure and is frequently associated with life threatening complications. The aim of this study was to investigate the effect of the C-MAC video laryngoscope on laryngeal view and intubation success compared to direct laryngoscopy.
Methods: In a single center, prospective, comparative before-after study in an anesthetist-lead surgical intensive care unit of a tertiary university hospital predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a two-year study period (first year: Macintosh laryngoscopy (ML), second year: C-MAC).
Results: A total of 274 critically ill patients requiring endotracheal intubation were included. 113 intubations using ML and 117 intubations using the C-MAC were assessed. In patients with at least one predictor for difficult intubation, C-MAC resulted in more successful intubations on first attempt compared to ML (34/43; 79% vs. 21/38; 55%), P=0.03. The visualization of the glottis with ML using Cormack and Lehane (C&L) grading, was more frequently rated as difficult (20%; C&L 3 and 4) compared to C-MAC (7%, C&L 3 and 4), P<0.0001.
Conclusions: Use of the C-MAC video laryngoscope improved laryngeal imaging and improved intubating success rate on first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potential difficult endotracheal intubations regularly occur.
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