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February 7, 2017

Video Laryngoscopy in the Intensive Care Unit: Seeing Is Believing, But That Does Not Mean It’s True

Author Affiliations
  • 1Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
  • 2Pulmonary and Critical Care Medicine, Intermountain Medical Center and the University of Utah School of Medicine, Murray
JAMA. 2017;317(5):479-480. doi:10.1001/jama.2016.21036

Tracheal intubation is a lifesaving skill essential to the practice of anesthesia, emergency medicine, and critical care. Since the invention of direct laryngoscopy blades by Miller and Macintosh in the 1940s, the technology used for tracheal intubation was largely unchanged until the introduction of video laryngoscopy in the late 1990s.1 Today multiple video laryngoscopes provide excellent, albeit indirect, views of the larynx without the need for aligning the laryngeal axis with the clinician’s line of sight. Evidence suggesting that the use of these devices improved visualization of the larynx and facilitated intubation in difficult airways led to the incorporation of video laryngoscopy into the American Society of Anesthesiologists’ difficult airway algorithm in 2013.2 The striking ease of achieving laryngeal visualization and proliferation of video laryngoscopy devices soon resulted in the extension of video laryngoscopy to use outside the operating room and to patients without a difficult airway. Early data suggested that video laryngoscopy might improve intubation success rates in the intensive care unit (ICU) and emergency department. However, the validity of this evidence was limited by observational design or abnormally low success rates in the direct laryngoscopy group.3,4