Analysis of orotracheal intubation techniques in the intensive care unit.

BACKGROUND The development of specialised airway tools help laryngoscopists secure the airway in intensive care units. The use of videolaryngoscopy has been suggested in simulation studies, and human studies suggest that this advanced airway tool may have an advantage for difficult airways; however, less is known about its use in the ICU. OBJECTIVE To compare orotracheal intubation before and after acquisition of an ICU-dedicated GlideScope (GS), and to determine the incidence of complications with orotracheal intubation in an ICU. METHODS An observational study was conducted from October 2008 to April 2009 to record the use of advanced airway tools including videolaryngoscopy before ("pre-GS") and immediately after ("post-GS") the purchase of an ICUdedicated videolaryngoscope. Reasons for intubation, response time, type of intubation, number of attempts at intubation, reasons for delays in intubation, risk factors for difficult intubation and complications were compared between these groups. RESULTS 56 patients were intubated pre-GS and 47 post- GS. Although a significant increase in videolaryngoscopy was observed in the ICU (P = 0.001), no significant reduction in total attempts at orotracheal intubation were observed (P = 0.66), and that the incidence of overall complications were not reduced (P = 0.21). CONCLUSIONS The use of a new airway tool may not necessarily lead to immediate reduction in attempts at orotracheal intubation or in overall complication rates.