Role of intubating laryngeal mask airway for endotracheal intubation in the intensive care unit: an observational trial

Purpose Avoidance of further worsening of hypoxemia is a prime objective during intubation of patients with acute respiratory failure. The aim of this study was to compare conventional laryngoscopy with intubating laryngeal mask airway (ILMA) with the aid of flexible fiberoptic bronchoscopes (FOBs) for intubation of class III/IV Coramck–Leahne patients in the intensive care unit. Materials and methods After failure of an initial attempt at intubation using conventional direct laryngoscopy, 112 Cormack–Lehane class III/IV patients were subjected to repeated attempts of intubation using either a Macintosh-type laryngoscope (ML, n = 59) or an ILMA with FOB (n = 53). After failure of two further trials using either technique, intubation would be attempted using the GlideScope video laryngoscope. The primary outcome was the incidence of severe hypoxemia (defined as arterial saturation 80%). Secondary outcomes were intubating time, number of attempts, and incidence of other complications. Results Twenty-five patients (42.2%) in the ML group suffered from severe hypoxemia, compared with eight (15.1%) patients in ILMA group (P = 0.002). The median (interquartile range) intubating time was 39 s (32.3–87.8 s) in the ML group versus 102 s (73.8–123 s) in the ILMA group (P 0.001). Multiple logistic regression showed that the intubating technique was the only intubation-related predictor of severe hypoxemia (odds ratio, 4.08; 95% confidence interval, 1.63–10.18; P = 0.003). Both groups were comparable as regards the incidence of other intubation-related complications and postintubation course in the intensive care unit (P 0.05). Conclusion In Cormack–Lehane class III/IV patients who failed to be intubated in the first attempt, retrying intubation using the ILMA with the aid of a flexible FOB was associated with a lower incidence of severe hypoxemia.