Direct laryngoscopy versus videolaryngoscopy in COVID-19 patient intubation

Abstract

Introduction: Many COVID-19 patients require ventilation. Direct laryngoscopy is the traditional method used for airway management; however, videolaryngoscopy is an alternative in these patients.

Objective: To compare direct laryngoscopy and videolaryngoscopy for airway management in COVID-19 patients.

Methods: A retrospective observational study was carried out. The universe and the sample consisted of patients intubated by physicians from Henry Reeve brigade at hospitals in Cancun and Mexico City. Two groups were formed: the direct laryngoscopy group, with 91 patients, and the videolaryngoscopy group, with 103 patients. The variables studied were age, sex, number of predictors of an anatomically difficult airway, visualization of the glottic opening, intubation attempts, and intubation complications. Statistical analysis of the data was performed using the SPSS 23.0 statistical package.

Results: The groups were comparable in terms of age, sex and predictors of an anatomically difficult airway. Complete or partial glottic visualization in the videolaryngoscopy group was 97 %, while in the direct laryngoscopy group it was 86 %. Endotracheal intubation at the first attempt exceeded 70 % in the videolaryngoscopy group and 50 % in the direct laryngoscopy group. The main complications observed were desaturation and arterial hypotension with a higher frequency in the direct laryngoscopy group (40.7 % and 49.5 %, respectively).

Conclusions: Video laryngoscopy improved glottic visualization and endotracheal intubation at the first attempt, with fewer complications in the patients studied.

Keywords: videolaryngoscopy; direct laryngoscopy; endotracheal intubation; COVID-19.