Awake Tracheal Intubation in Critical Care Patients

Study Overview
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Brief Summary
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Tracheal intubation in critical care is a high-risk procedure requiring significant expertise and airway strategy modifications, such as awake intubation with video laryngoscope or flexible endoscope intubation. Furthermore, delayed sequence intubation can be used by experts in certain high-risk subgroups. The investigators hypothesise that awake tracheal intubation is associated with a lower incidence of severe adverse events than standard tracheal intubation in critical care patients.

Detailed Description
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Intubation records from 2020 to 2022 were acquired to examine all tracheal intubations of critical care patients at a tertiary hospital. Each awake tracheal intubation (awake) case - all of which were performed using a videolaryngoscope with a hyperangulated blade - was propensity matched with two controls (1:2 ratio; standard intubation videolaryngoscopy (VL) and direct laryngoscopy (DL) undergoing general anaesthesia), with similar comorbidities and intubations performed after the induction of anaesthesia (asleep).

Official Title
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Awake Tracheal Intubation is Associated With Fewer Adverse Events in Critical Care Patients Than Standard Tracheal Intubation

Conditions
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Videolaryngoscopy, Intensive Care Unit Syndrome

Intervention / Treatment
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* Device: tracheal intubation using videolaryngoscope with a hyperangulated blade or standard intubation videolaryngoscopy (VL) and direct laryngoscopy (DL)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Data for all critical care patients requiring tracheal intubation during the study period Exclusion Criteria: included incomplete data reports

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| awake<br>awake tracheal intubation | Device: tracheal intubation using videolaryngoscope with a hyperangulated blade or standard intubation videolaryngoscopy (VL) and direct laryngoscopy (DL)<br>* In the awake group tracheal intubation performed by an videolaryngoscope with a hyperangulated blade. In the asleep group the standard intubation were performed by videolaryngoscopy (VL) and direct laryngoscopy (DL)<br>|
| asleep<br>standard intubation videolaryngoscopy (VL) and direct laryngoscopy (DL) | Device: tracheal intubation using videolaryngoscope with a hyperangulated blade or standard intubation videolaryngoscopy (VL) and direct laryngoscopy (DL)<br>* In the awake group tracheal intubation performed by an videolaryngoscope with a hyperangulated blade. In the asleep group the standard intubation were performed by videolaryngoscopy (VL) and direct laryngoscopy (DL)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hypotension | defined as a mean arterial pressure < 55 mmHg | during intubation procedure (within 30 Minutes) | 
| cardiac arrest | defined as a peri-interventional cardiac arrest | during intubation procedure (within 30 Minutes) | 
| desaturation | defined as SpO2 < 80% after sufficient preoxygenation | during intubation procedure (within 30 Minutes) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cormack and Lehane classification (Class I-IV) | glottis visualisation | during intubation procedure (< 120 seconds) | 
| FPS | First Pass Intubation success | during intubation procedure (< 120 seconds) | 
| Airway Injury | dental injury | during intubation procedure (< 120 seconds) | 
| other adverse events | soft tissue injury | during intubation procedure (< 120 seconds) |