Macintosh Blade Size for Endotracheal Intubation in Operative Rooms (MacSize_OR)


University Hospital, Clermont-Ferrand


Not yet enrolling


Endotracheal Intubation
Intubation Complication
Intubation; Difficult or Failed


Device: Direct laryngoscopy using Macintosh blade

Study type


Funder types



IRB 00010254-2023-081

Details and patient eligibility


Endotracheal intubation is a frequent procedure in the operating room but optimal Macintosh blade size remains unknown to date.

Full description

Endotracheal intubation is an extremely frequent procedure in the operating room, in intensive care units and in emergency medicine (in- or out-of-hospital). Apart from special cases of foreseen difficult programmed intubation, direct laryngoscopy remains the most frequently used technique. It requires the use of a handle (short or long), which serves as a light source on which is adapted a Macintosh curved blade, metallic or plastic, single or multiple use. The choice of blade size is based on the experience of the physician. Most often, in adult settings, size 3 or 4 blades are used. The very spartan literature on the subject and the current recommendations do not provide any information on the choice of blade size. Our team (and others) recently concluded that intubation first attempt rates in intensive care units or emergency settings were improved when using shorter Macintosh blade size No3 vs 4 (Godet et al. Intensive Care Medicine 2022 and Landefeld et al. Critical Care Explorations 2023). We therefore wish to evaluate these practices in terms of success of the first laryngoscopy, Cormack-Lehane and POGO (percentage of glottic opening visualized) scores, the need to use an alternative technique or a second operator in operative rooms. The results will be analyzed with regard as a function and experience of the person performing the laryngoscopy, as well as the setting (urgent or scheduled). These data are usually collected during the performance of an endotracheal intubation in a nationwide fashion in French operative rooms.


3,000 estimated patients




18+ years old


No Healthy Volunteers

Inclusion criteria

  • Patients must be admitted in a participating operative room and require mechanical ventilation through an orotracheal tube.
  • Adult (age ≥ 18 years)
  • Subjects must be covered by public health insurance
  • Written informed consent from the patient or proxy (if present) before inclusion or once possible when patient has been included in a context of emergency.

Exclusion criteria

  • Anticipated difficult intubation requiring videolaryngoscopy or other technic in first place
  • Nasotracheal intubation
  • Refusal of study participation or to pursue the study by the patient
  • Absence of coverage by the French statutory healthcare insurance system
  • Protected person

Trial design

3,000 participants in 2 patient groups

Macintosh blade size 3
Patients intubated using Macintosh blade size 3
Device: Direct laryngoscopy using Macintosh blade
Macintosh blade size 4
Patients intubated using Macintosh blade size 4
Device: Direct laryngoscopy using Macintosh blade

Trial contacts and locations



Central trial contact

Thomas Godet, MD, PhD; Dominique Morand, PhD

Data sourced from

Clinical trials

Find clinical trialsTrials by location
© Copyright 2024 Veeva Systems