Hyperangulated vs Macintosh Blades for Intubation With Videolaryngoscopy in ICU (INVIBLADE)

Hospital Clinico Universitario de Santiago

Status: Enrolling

Conditions: Videolaryngoscopy; Intubation; Acute Respiratory Failure; Intubation Complication; Intubation; Difficult or Failed

Treatments: Device: Macintosh blade videolaryngoscope; Device: Hyperangulated blade videolaryngoscope

Study type: Interventional

Funder types: Other

Identifiers

NCT06322719

INVIBLADE

Details and patient eligibility

About

Tracheal intubation in the intensive care unit (ICU) is associated with high incidence of difficult intubation and complications. Videolaryngoscopes (VLs) devices have been proposed to improve airway management, and the use of VLs are recommended as first-line or after a first-attempt failure using direct laryngoscopy in ICU airway management algorithms. Although until relatively few years ago there were doubts about whether videolaryngoscopes had advantages over direct laryngoscopy for endotracheal intubation (ETI) in critically ill patients, two recent studies (DEVICE (1), INTUBATE (2)), and a Cochrane review (3) have confirmed that videolaryn should be used?, and what is the best blade? . There are two types of blades commonly used with videolaryngoscopes: the "Macintosh" blade with a slight curvature, and hyperangulated blades. The "Macintosh" blades have a lower angle of vision, but they have the advantage of being similar to the blades commonly used in direct laryngoscopy, making them easy to use for the person performing the ETI. Hyperangulated blades have a greater angle of vision, improving glottic visualization, especially in patients with an anterior glottis. However, the need to overcome this angulation could potentially hinder the passage of the endotracheal tube to the vocal cords. It is unknown if either blade has any advantage for intubating critically ill patients.

Full description

The purpose of this prospective multicenter randomized study is to compare successful intubation on the first attempt with the Macintosh videolaryngoscope vs the hyperangulated videolaryngoscope during tracheal intubation in ICU patients.The hypothesis of the study is that tracheal intubation using the hyperangulated videolaryngoscope will improve the frequency of successful intubation on the first attempt in ICU patients requiring intubation in the intensive care unit.

Enrollment: 1,036 estimated patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 18 years or older.
• Admitted to an Intensive Care Unit.
• Need for tracheal intubation during the stay in the ICU.
• The device to be used for intubation is a videolaryngoscope

Exclusion criteria

• Pregnancy or lactation.
• Emergent tracheal intubation that does not allow for the randomization of the procedure.
• Need for tracheal intubation with a device other than the videolaryngoscope (fiberoptic bronchoscope, direct laryngoscopy, tracheostomy, etc.).
• Tracheal intubation performed outside the ICU (Emergency Department, Hospital ward, etc.).

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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1,036 participants in 2 patient groups

Hyperangulated videolaryngoscope

Experimental group

Description:

Tracheal intubation facilitated by a hyperangulated videolaryngoscope

Treatment:

Device: Hyperangulated blade videolaryngoscope

Macintosh videolaryngoscope

Active Comparator group

Description:

Tracheal intubation facilitated by a videolaryngoscope with a Macintosh type blade

Treatment:

Device: Macintosh blade videolaryngoscope