Optimizing Intubation Success: A Comparative Study of Video and Direct Laryngoscopy in Critically Ill Adults (The DEVICE Trial)
This multicenter, randomized trial evaluated the effectiveness and safety of video laryngoscopy compared to direct laryngoscopy in critically ill adults undergoing tracheal intubation in emergency departments and intensive care units (ICUs). The study aimed to determine if video laryngoscopy increases the likelihood of successful first-attempt tracheal intubation and whether it impacts the occurrence of severe complications during intubation.
The study included 1,417 patients. The primary outcome, successful first-attempt intubation, occurred in 85.1% of the video-laryngoscope group, significantly higher than the 70.8% success rate in the direct-laryngoscope group. The secondary outcome, severe complications during intubation (e.g., severe hypoxemia, severe hypotension, new or increased vasopressor use, cardiac arrest, or death), was similar between the two groups. Other safety outcomes, such as esophageal intubation, injury to the teeth, and aspiration, were also comparable in both groups.
What do you prefer to use for intubation in your ICU?
0%Video laryngoscopy (VL)
0%Direct laryngoscopy (DL)
0%Unfortunately, VL is not available in my ICU
Conclusively, the use of a video laryngoscope was associated with a higher success rate of first-attempt tracheal intubation among critically ill adults compared to a direct laryngoscope. The study's findings could influence intubation practices in emergency departments and ICUs, particularly considering that unsuccessful first-attempt intubations are associated with life-threatening complications.
Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults | NEJM