SCCMPod-545 CCM: Improving Intubation in Critical Illness

In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle B. Enfield, MD, FCCM, speaks with Garrett McDougall, MS, MSc, and Ben Forestell, MD, of McMaster University about their recent study, “Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials,” published in the November 2024 issue of Critical Care Medicine. The study included 20 randomized controlled trials encompassing 4569 patients to investigate whether video laryngoscopy (VL) offers advantages over direct laryngoscopy (DL) for intubation in critically ill patients.  A key finding of the study was that VL probably improves first-pass success rates and reduces the risk of esophageal intubation and dental injury. These benefits extend across the spectrum of operator experience, especially among novice operators but also among seasoned operators.   Drs. McDougall and Forestell discuss findings that surprised them, such as seeing equal benefit for standard VL and hyperangulated VL devices. Additionally, no clear benefits were found for patients who were intubated emergently with VL as compared to those who underwent elective intubation. The discussion covers what could be next for resuscitation and airway research in critically ill patients. There may be more to learn about scenarios involving difficult airways, soiled airways, and emergent versus elective intubation. More research on device characteristics could also provide important insights. To wrap up, the guests underscore the importance of maintaining both VL and DL proficiency since DL can be a more appropriate choice for some patients. Resources referenced in this episode: Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials (McDougall GG, et al. Crit Care Med. 2024;52:1674-1685).