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

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 randomi...

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Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Original
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144872/
https://www.ncbi.nlm.nih.gov/pubmed/34032882
http://dx.doi.org/10.1007/s00134-021-06417-y
Descripción
Sumario: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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00134-021-06417-y.

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