Dataset Information

Does glycopyrrolate premedication facilitate tracheal intubation with a rigid video-stylet?: A randomized controlled trial.

ABSTRACT:

Background

A rigid video-stylet intubation device provides safe and accurate access to the trachea by enabling visualization of the airway structures during tracheal intubation. The primary purpose of this study was to examine the effects of glycopyrrolate premedication on tracheal intubation with a rigid video-stylet.

Methods

In this prospective, randomized, double-blinded study, 78 patients were randomly assigned to the control group (n = 39; no glycopyrrolate administration) or the glycopyrrolate group (n = 39; 0.005 mg/kg glycopyrrolate, intramuscular injection). A rigid video-stylet was used for tracheal intubation. The degree of oral secretion observed through the video-stylet monitor was assessed using the OptiScope laryngeal view and graded on a 4-point scale (1, excellent; 2, good; 3, poor; and 4, unacceptable). The time to intubation and hemodynamic variables at baseline and 1, 3, and 5 minutes after intubation were recorded.

Results

The OptiScope laryngeal view grades of the glycopyrrolate group (grade 1 = 16 [41.0%], 2 = 17 [43.6%], 3 = 6 [15.4%], and 4 = 0 [0%]) were significantly higher than those of the control group (grade 1 = 9 [23.1%], 2 = 11 [28.2%], 3 = 18 [46.2%], and 4 = 1 [2.6%]; P = .02). The intubation time was shorter in the glycopyrrolate group (18.5 seconds [15.0-22.0]) than the control group (22.0 seconds [17.9-26.4], P = .02). There was no significant difference in the hemodynamic variables between groups.

Conclusion

Glycopyrrolate facilitated tracheal intubation with a rigid video-stylet by decreasing oral secretions and providing better visualization and faster intubation with hemodynamic stability.

Trial registry

www.clinicaltrials.gov; Identifier: NCT03050242.

SUBMITTER: Cho EA

PROVIDER: S-EPMC6133530 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Does glycopyrrolate premedication facilitate tracheal intubation with a rigid video-stylet?: A randomized controlled trial.

Cho Eun-Ah EA Hwang Sung-Ha SH Lee Sung Hyun SH Ryu Kyoung-Ho KH Kim Yun-Hong YH

Medicine 20180801 32

<h4>Background</h4>A rigid video-stylet intubation device provides safe and accurate access to the trachea by enabling visualization of the airway structures during tracheal intubation. The primary purpose of this study was to examine the effects of glycopyrrolate premedication on tracheal intubation with a rigid video-stylet.<h4>Methods</h4>In this prospective, randomized, double-blinded study, 78 patients were randomly assigned to the control group (n = 39; no glycopyrrolate administration) or ...[more]

PMID: 30095660

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Project description:ImportanceFor critically ill adults undergoing emergency tracheal intubation, failure to intubate the trachea on the first attempt occurs in up to 20% of cases and is associated with severe hypoxemia and cardiac arrest. Whether using a tracheal tube introducer ("bougie") increases the likelihood of successful intubation compared with using an endotracheal tube with stylet remains uncertain.ObjectiveTo determine the effect of use of a bougie vs an endotracheal tube with stylet on successful intubation on the first attempt.Design, setting, and participantsThe Bougie or Stylet in Patients Undergoing Intubation Emergently (BOUGIE) trial was a multicenter, randomized clinical trial among 1102 critically ill adults undergoing tracheal intubation in 7 emergency departments and 8 intensive care units in the US between April 29, 2019, and February 14, 2021; the date of final follow-up was March 14, 2021.InterventionsPatients were randomly assigned to use of a bougie (n = 556) or use of an endotracheal tube with stylet (n = 546).Main outcomes and measuresThe primary outcome was successful intubation on the first attempt. The secondary outcome was the incidence of severe hypoxemia, defined as a peripheral oxygen saturation less than 80%.ResultsAmong 1106 patients randomized, 1102 (99.6%) completed the trial and were included in the primary analysis (median age, 58 years; 41.0% women). Successful intubation on the first attempt occurred in 447 patients (80.4%) in the bougie group and 453 patients (83.0%) in the stylet group (absolute risk difference, -2.6 percentage points [95% CI, -7.3 to 2.2]; P = .27). A total of 58 patients (11.0%) in the bougie group experienced severe hypoxemia, compared with 46 patients (8.8%) in the stylet group (absolute risk difference, 2.2 percentage points [95% CI, -1.6 to 6.0]). Esophageal intubation occurred in 4 patients (0.7%) in the bougie group and 5 patients (0.9%) in the stylet group, pneumothorax was present after intubation in 14 patients (2.5%) in the bougie group and 15 patients (2.7%) in the stylet group, and injury to oral, glottic, or thoracic structures occurred in 0 patients in the bougie group and 3 patients (0.5%) in the stylet group.Conclusions and relevanceAmong critically ill adults undergoing tracheal intubation, use of a bougie did not significantly increase the incidence of successful intubation on the first attempt compared with use of an endotracheal tube with stylet.Trial registrationClinicalTrials.gov Identifier: NCT03928925

Dataset Information

Does glycopyrrolate premedication facilitate tracheal intubation with a rigid video-stylet?: A randomized controlled trial.

Background

Methods

Results

Conclusion

Trial registry

Publications

Does glycopyrrolate premedication facilitate tracheal intubation with a rigid video-stylet?: A randomized controlled trial.

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