Hyperangulated vs Macintosh Blades for Intubation With Videolaryngoscopy in ICU

Description

Tracheal intubation in the intensive care unit (ICU) is associated with high incidence of difficult intubation and complications. Videolaryngoscopes (VLs) devices have been proposed to improve airway management, and the use of VLs are recommended as first-line or after a first-attempt failure using direct laryngoscopy in ICU airway management algorithms. Although until relatively few years ago there were doubts about whether videolaryngoscopes had advantages over direct laryngoscopy for endotracheal intubation (ETI) in critically ill patients, two recent studies (DEVICE (1), INTUBATE (2)), and a Cochrane review (3) have confirmed that videolaryn should be used?, and what is the best blade? . There are two types of blades commonly used with videolaryngoscopes: the "Macintosh" blade with a slight curvature, and hyperangulated blades. The "Macintosh" blades have a lower angle of vision, but they have the advantage of being similar to the blades commonly used in direct laryngoscopy, making them easy to use for the person performing the ETI. Hyperangulated blades have a greater angle of vision, improving glottic visualization, especially in patients with an anterior glottis. However, the need to overcome this angulation could potentially hinder the passage of the endotracheal tube to the vocal cords. It is unknown if either blade has any advantage for intubating critically ill patients.

Interventions

• Hyperangulated blade videolaryngoscope (Device)
  For patients assigned to the Hyperangulated videolaryngoscope Group, the operator will use a Hyperangulated video laryngoscope on the first laryngoscopy attempt.
• Macintosh blade videolaryngoscope (Device)
  For patients assigned to the Macintosh videolaryngoscope Group, the operator will use a Hyperangulated video laryngoscope on the first laryngoscopy attempt.

Eligibility criteria

Conditions

Locations

• University Clinical Hospital of Santiago de Compostela — Santiago de Compostela, A Coruña, Spain
• Complexo Hospitalario Universitario de A Coruña — A Coruña, Spain
• Hospital General de Albacete — Albacete, Spain
• Hospital de la Santa Creu i Sant Pau, Barcelona — Barcelona, Spain
• Hospital Universitario de Cáceres — Cáceres, Spain
• Hospital de Denia — Denia, Spain
• Hospital General Universitario de Eche — Elche, Spain
• Hospital Universitario de Cabueñes, Gijón — Gijón, Spain
• Hospital Virgen de las Nieves, Granada — Granada, Spain
• Hospital Universitario de Gran Canaria Doctor Negrín — Las Palmas de Gran Canaria, Spain
• Complejo Asistencial Universitario de León — León, Spain
• Hospital Universitario Lucus Augusti, Lugo — Lugo, Spain
• Hospital Gregorio Marañón, Madrid — Madrid, Spain
• Hospital Universitario 12 de Octubre, Madrid — Madrid, Spain
• Hospital Universitario La Paz, Madrid — Madrid, Spain
• Hospital Universitario La Princesa — Madrid, Spain
• Hospital Universitario Puerta de Hierro, Majadahonda — Majadahonda, Spain
• Hospital Universitario de Móstoles — Móstoles, Spain
• Complexo Hospitalario Universitario de Ourense — Ourense, Spain
• Hospital Universitario Central de Asturias (HUCA), Oviedo — Oviedo, Spain
• Clínica Universidad de Navarra, Pamplona — Pamplona, Spain
• Complexo Hospitalario Universitario de Pontevedra — Pontevedra, Spain
• Hospital Universitario Donostia, San Sebastián — San Sebastián, Spain
• Hospital Universitario Marqués de Valdecilla, Santander — Santander, Spain
• Complejo Asistencial de Segovia — Segovia, Spain
• Hospital Clínico Universitario de Valencia — Valencia, Spain
• Hospital Universitario La Fe de Valencia — Valencia, Spain
• Complexo Hospitalario Universitario Álvaro Cunqueiro de Vigo — Vigo, Spain
• Hospital Ribera Povisa Vigo — Vigo, Spain