Comparison of endotracheal intubation using direct and video laryngoscopes in the ICU

colleagues [1] demonstrated that, compared with the Macintosh direct laryngoscope (MDL), the C-MAC videolaryngoscope (C-MAC) improved laryngeal view and achieved a higher intubation success rate on first attempt in patients with predictors of difficult intubation in the ICU. In the Materials and methods, however, the authors did not mention what position the patient’s head was placed during laryngoscopy. is may be un important for the C-MAC, which does not require the alignment of the oral, pharyngeal, and tracheal axes to visualize the glottis [2]. When using the MDL, however, the patient’s head should always be in a sniffing position, which aligns the oral, pharyngeal, and laryngeal axis into more of a straight line [3]. We believe that when the laryngoscopic views with direct and video laryngoscopes are used as endpoints, negligence of this factor would have significantly underestimated the performance of the MDL, particularly in patients with predictors of difficult intubation. In a two-year study period, endotracheal intubation was successfully performed in 113 patients using the MDL and 117 patients using the C-MAC. Of those, there were no differences in the number of intubation attempts between the two devices. Moreover, both use of alternative airway devices after failed intu bation with the MDL and C-MAC devices (27 out of 140 versus 17 out of 134) and the lowest oxygen saturation during intubation did not significantly differ between the two groups. Interestingly, eight patients in whom intu bation with the C-MAC failed were successfully rescued with the MDL. us, this study would not achieve the conclusion that the C-MAC outperforms the MDL for endotracheal intubation in the ICU patients. Two recent randomized, controlled manikin studies by emergency physicians and/ or anesthetists showed that none of five indirect laryngoscopes, including the Glidescope, C-MAC, Pentax AWS, Airtraq, and McGrath, outperformed the MDL for emergency difficult intubation [4,5].