Effect of COVID-19 Pandemic on the Use of Video Laryngoscopy During Tracheal Intubation of Critically Ill Adults

Abstract

Rationale: Significant variability exists in the use of direct versus video laryngoscopy for the intubation of critically ill adults. Concerns regarding risks of infection to healthcare providers have led many experts to recommend the use of video laryngoscopy for intubation of patients with COVID-19. This recommendation is based on the belief that using video laryngoscopy allows more physical distance between the operator and the patient, potentially decreasing the risk to providers. Information on the effect of the COVID-19 pandemic on intubation practices is currently limited. Methods: We conducted a survey of intubation practices in 21 emergency departments and intensive care units participating in either of two randomized trials (clinicaltrials.gov identifiers: NCT03928925 and NCT03787732) within the Pragmatic Critical Care Research Group. At each site, the site investigator estimated the prevalence of various airway practices among 3 groups of patients: 1) patients intubated prior to the COVID-19 pandemic, 2) patients intubated with known or suspected COVID-19, and 3) patients intubated during the pandemic without known or suspected COVID-19. The site investigator provided information on use of personal protective equipment, preintubation fluid bolus administration, preoxygenation, sedative choice, paralytic choice, approach to oxygenation from induction to intubation, approach to laryngoscopy, bougie use, primary operator, and ancillary staff present. The primary outcome was the proportion of intubations at a study site that was estimated to be performed using video laryngoscopy. Results: We received responses from 19 of 21 sites (90%). Investigators reported that video laryngoscopy was used in a median of 65% of intubations [IQR: 50-76%] at their site prior to the pandemic compared with a median of 100% of intubations [IQR: 76-100%] for patients with known or suspected COVID-19 (p= 0.0002). Prior to the pandemic only 2 sites (10.5%) reported using exclusively video laryngoscopy, compared to 10 sites (52.6%) that reported using exclusively video laryngoscopy for COVID-19 patients. For patients without known or suspected COVID-19, use of video versus direct laryngoscopy did not differ significantly between patients intubated before the pandemic and patients intubated during the pandemic. Conclusions: Among patients intubated at 19 emergency departments and intensive care units participating in two ongoing clinical trials, we found that the perceived use of video laryngoscopy was greater for patients with known or suspected COVID-19 compared to patients intubated prior to the pandemic, whereas perceived use of video laryngoscopy for patients without COVID-19 during the pandemic was similar to use prior to the pandemic.