학술논문
Effect of Laryngoscope Blade Size on First Pass Success of Tracheal Intubation in Critically Ill Adults
Document Type
Academic Journal
Author
Landefeld, Kevin R.; Koike, Seiji; Ran, Ran; Semler, Matthew W.; Barnes, Christopher; Stempek, Susan B.; Janz, David R.; Rice, Todd W.; Russell, Derek W.; Self, Wesley H.; Vonderhaar, Derek; West, Jason R.; Casey, Jonathan D.; Khan, Akram; Ginde, Adit A.; Gandotra, Sheetal; Driver, Brian E.; Prekker, Matthew E.; Trent, Stacy; Janz, David R.; Russell, Derek W.; Rice, Todd W.; Self, Wesley H.; Gibbs, Kevin
Source
Critical Care Explorations. Mar 01, 2023 5(3):e0855-e0855
Subject
Language
English
ISSN
2639-8028
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.