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Effect of the use of an endotracheal tube and stylet versus an endotracheal tube alone on first-attempt intubation success: a multicentre, randomised clinical trial in 999 patients.
Jaber, Samir; Rollé, Amélie; Godet, Thomas; Terzi, Nicolas; Riu, Béatrice; Asfar, Pierre; Bourenne, Jeremy; Ramin, Séverin; Lemiale, Virginie; Quenot, Jean-Pierre; Guitton, Christophe; Prudhomme, Eloi; Quemeneur, Cyril; Blondonnet, Raiko; Biais, Mathieu; Muller, Laurent; Ouattara, Alexandre; Ferrandiere, Martine; Saint-Léger, Piehr; Rimmelé, Thomas; Pottecher, Julien; Chanques, Gerald; Belafia, Fouad; Chauveton, Claire; Huguet, Helena; Asehnoune, Karim; Futier, Emmanuel; Azoulay, Elie; Molinari, Nicolas; De Jong, Audrey.
  • Jaber S; Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France. s-jaber@chu-montpellier.fr.
  • Rollé A; Département d'Anesthésie Réanimation B (DAR B), Hôpital Saint-Eloi, 80 Avenue Augustin Fliche, 34295, Montpellier, France. s-jaber@chu-montpellier.fr.
  • Godet T; Department of Intensive Care, Guadeloupe University Hospital, French Caribbean, France.
  • Terzi N; Department of Peri-Operative Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
  • Riu B; Department of Medical Intensive Care, CHU de Grenoble-Alpes, 38000, Grenoble, France.
  • Asfar P; Critical Care Unit, University Teaching Hospital of Purpan, Place du Dr Baylac, 31059, Toulouse Cedex 9, France.
  • Bourenne J; Département de Médecine Intensive-Réanimation, CHU d'Angers, Université d'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
  • Ramin S; AP-HM, Emergency and Critical Care Medicine, Aix Marseille University, University Hospital Timone, Marseille, France.
  • Lemiale V; Anesthesiology and Intensive Care, Anesthesia and Critical Care Department A, Lapeyronie Teaching Hospital, Montpellier Cedex 5, France.
  • Quenot JP; Médecine Intensive et Réanimation, Groupe FAMIREA, Hôpital Saint-Louis, Université de Paris, Paris, France.
  • Guitton C; Department of Intensive Care, François-Mitterrand University Hospital, 14, rue Paul Gaffarel, 21000, Dijon, France.
  • Prudhomme E; Lipness Team, Inserm Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, 21000, Dijon, France.
  • Quemeneur C; Inserm CIC 1432, Clinical Epidemiology, University, Dijon, France.
  • Blondonnet R; Intensive Care Unit, General Hospital Center, Le Mans, France.
  • Biais M; Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015, Marseille, France.
  • Muller L; Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, Faculté de Médecine, 13005, Marseille, France.
  • Ouattara A; Department of Anaesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, Paris, France.
  • Ferrandiere M; Department of Peri-Operative Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
  • Saint-Léger P; Anesthesiology and Critical Care Department, CHU Bordeaux, 33000, Bordeaux, France.
  • Rimmelé T; Univ. Bordeaux Segalen, 33000, Bordeaux, France.
  • Pottecher J; Department of Intensive Care, Nîmes University Hospital, Nîmes, France.
  • Chanques G; Department of Anaesthesia and Critical Care, CHU Bordeaux,, Magellan Medico-Surgical Centre, 33000, Bordeaux, France.
  • Belafia F; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, 33600, Pessac, France.
  • Chauveton C; Département Anesthésie Réanimation, Université de Tours, CHU de Tours, Tours, France.
  • Huguet H; Department of Intensive Care, General Hospital Center, Valenciennes, France.
  • Asehnoune K; Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, EA, 7426, Lyon, France.
  • Futier E; Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation & Médecine Péri-Opératoire-Université de Strasbourg, FMTS, EA3072, Strasbourg, France.
  • Azoulay E; Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France.
  • Molinari N; Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France.
  • De Jong A; Clinical Research Department of Montpellier University Hospital, Montpellier, France.
Intensive Care Med ; 47(6): 653-664, 2021 06.
Article in English | MEDLINE | ID: covidwho-1263138
Semantic information from SemMedBD (by NLM)
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6. Complication PROCESS_OF Patients
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7. Single Group Study USES Tracheal tube
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8. Critical Illness PROCESS_OF Adult
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9. Intubatio TREATS C0010340
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12. Stylet, device compared_with Endotracheal tube
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Endotracheal tube
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Endotracheal tube
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Tracheal tube
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ABSTRACT

PURPOSE:

The effect of the routine use of a stylet during tracheal intubation on first-attempt intubation success is unclear. We hypothesised that the first-attempt intubation success rate would be higher with tracheal tube + stylet than with tracheal tube alone.

METHODS:

In this multicentre randomised controlled trial, conducted in 32 intensive care units, we randomly assigned patients to tracheal tube + stylet or tracheal tube alone (i.e. without stylet). The primary outcome was the proportion of patients with first-attempt intubation success. The secondary outcome was the proportion of patients with complications related to tracheal intubation. Serious adverse events, i.e., traumatic injuries related to tracheal intubation, were evaluated.

RESULTS:

A total of 999 patients were included in the modified intention-to-treat

analysis:

501 (50%) to tracheal tube + stylet and 498 (50%) to tracheal tube alone. First-attempt intubation success occurred in 392 patients (78.2%) in the tracheal tube + stylet group and in 356 (71.5%) in the tracheal tube alone group (absolute risk difference, 6.7; 95%CI 1.4-12.1; relative risk, 1.10; 95%CI 1.02-1.18; P = 0.01). A total of 194 patients (38.7%) in the tracheal tube + stylet group had complications related to tracheal intubation, as compared with 200 patients (40.2%) in the tracheal tube alone group (absolute risk difference, - 1.5; 95%CI - 7.5 to 4.6; relative risk, 0.96; 95%CI 0.83-1.12; P = 0.64). The incidence of serious adverse events was 4.0% and 3.6%, respectively (absolute risk difference, 0.4; 95%CI, - 2.0 to 2.8; relative risk, 1.10; 95%CI 0.59-2.06. P = 0.76).

CONCLUSIONS:

Among critically ill adults undergoing tracheal intubation, using a stylet improves first-attempt intubation success.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / Intubation, Intratracheal Type of study: Controlled clinical trial / Etiology study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: Intensive Care Med Year: 2021 Document Type: Article Affiliation country: S00134-021-06417-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Critical Illness / Intubation, Intratracheal Type of study: Controlled clinical trial / Etiology study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: Intensive Care Med Year: 2021 Document Type: Article Affiliation country: S00134-021-06417-y