Please select the eligibility criteria that correspond to the clinical trial below.
Title: Randomized Controlled Trial to Evaluate the Efficacy of Video-laryngoscopy vs. Direct Laryngoscopy for Endotracheal Intubation in the Critically Ill Patients: A Pilot Study
Brief Summary: Endotracheal Intubation (ETI) is done to place a plastic tube in a patient's trachea (windpipe) to assist with breathing. Patients admitted to the intensive care unit (ICU) are the sickest of patients and the majority of them require this life saving procedure. A critical illness can be sudden and ETI required urgently. The doctors performing ETI in these situations may not be experts at ETI. Studies have shown that if it takes more than one attempt to get the tube in the right position patients can have severe complications such as: decrease level of oxygen in the body, decrease blood pressure, and cardiac arrest. These complications can be life threatening and increase the length of time spent in an ICU.

To perform ETI the doctor uses a metal tool called a laryngoscope that is placed through the patient's mouth to open the throat and then pass the tube into the trachea. The type of procedure that has been used for many years is called Direct Laryngoscopy (DL) which means that the doctor looks through the mouth directly into the throat. Newer technology is available and can be used at VGH called Video Laryngoscopy (VL). With VL there is a camera on the end of the laryngoscope and a video image is displayed on a monitor making it easier to see the entrance to the trachea. VL is not available for all cases at VGH and is unavailable in many other hospitals.

In this study we will compare DL to VL. Patients will be randomly placed in one of two groups: first attempt at ETI done with DL or first attempt of ETI done with DL. Patients will only be considered eligible for this study if the doctor feels that either DL or VL would be appropriate for the patient. In this pilot study we hope show that conducting a larger study would be feasible. If a larger study were to show that VL decreases complications and shortens length of ICU stay we would be able to recommend this procedure for all ETI at VGH as well as other hospitals where it currently may not be available.


Options:
A: Inclusion Criteria:

* Elective surgery requiring oral endotracheal intubation for general anesthesia;
* Anticipated extubation in the operating room;
* American Society of Anesthesiologists (ASA) physical status 1-3;
* Age between 18 and 99 years;
* Body Mass index ≥ 40 kg/m2.

Exclusion Criteria:

* Refusal of participation by attending anesthesiologist;
* Indicated rapid sequence induction for any reason including, but not limited to high risk of aspiration
* Indicated fiberoptic awake intubation.
B: Inclusion Criteria:

* Any patient over the age of 16 years, requiring urgent (within 30 minutes) endotracheal intubation, who are attended to by the critical care team will be eligible for enrolment

Exclusion Criteria:

* Patients who require intubation within 5 minutes or have contraindications to either of the study intubation technique will be ineligible
* cardiac arrest
* cardiopulmonary instability (oxygen saturation \<90% or systolic blood pressure \< 80 mmHg despite oxygen or fluid therapy)
* any clinical deterioration while awaiting randomization
* known prior or anticipated difficult intubation
* need for awake intubation (defined by sedation, topicalization and avoidance of neuromuscular blockade)
* pregnancy
* cervical spine precautions
* any patient deemed inappropriate for enrolment by the attending physician
C: Inclusion Criteria:

• Requiring orotracheal intubation

Exclusion Criteria:

* Contraindication to orotracheal intubation
* Time too short to allow inclusion and randomisation of patient (particularly cardiac arrest)
* Minor (\<18 )
* Pregnant, parturient , or breast-feeding woman
* Patient hospitalized without consent and/or deprived of liberty by court's decision
* Patient under guardianship or curators
* Lack of social insurance
* Lack of informed consent
* Concomitant inclusion in a trial whose primary endpoint focuses on intubation procedure
D: Inclusion Criteria:

* age \> 18years
* elective surgery
* single lumen endotracheal intubation required
* signed informed consent
* one risk factor for a difficult laryngoscopy ( Mallampati score \>3, inter-incisor gap \< 3.5cm, thyromental distance \< 6.5cm, sternomental distance \< 12.5cm, reduced neck extension and flexion)

Exclusion Criteria:

* lack of patient consent
* anesthesiologist declines to consent
* contraindication to neuromuscular blockade
* ASA 4
* rapid sequence intubation
* previous failed intubation
* other method of intubation indicated eg fiberoptic intubation, awake tracheostomy
* symptomatic gastro-esophageal reflux
* cervical spine instability
* unstable hypertension and symptomatic coronary artery disease
* cerebrovascular disease or raised intracranial pressure
* oral/pharyngeal/laryngeal carcinoma
* loose teeth/poor dentition

Answer: B