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 - CNRS - Centre national de la recherche scientifique Accéder directement au contenu
Article Dans Une Revue Intensive Care Medicine Année : 2021

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

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 Centre Hospitalier de Basse-Terre [Guadeloupe]
4 Pôle de Médecine Périopératoire [CHU Clermont-Ferrand]
5 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
6 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
7 CHU d'Angers [Département Urgences]
8 TIMONE - Hôpital de la Timone [CHU - APHM]
9 Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière]
10 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
11 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
12 CIC-EC - Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques
13 Service Réanimation médico-chirurgicale [CH Le Mans]
14 Service Anesthésie et Réanimation [Hôpital Nord - APHM]
15 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
16 GRC 29 - ARPE - Groupe de Recherche Clinique en Anesthésie Réanimation médecine PEriopératoire
17 CHU Clermont-Ferrand
18 Service Anesthésie - Réanimation [Bordeaux]
19 Université de Bordeaux Ségalen [Bordeaux 2]
20 Unité de réanimation médicale [CHU de Carémeau, Nîmes]
21 Magellan Medico-Surgical Center [Bordeaux]
22 Adaptation cardiovasculaire à l'ischémie
23 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
24 Centre hospitalier [Valenciennes, Nord]
25 Hôpital Edouard Herriot [CHU - HCL]
26 PI3 - Physiopathologie de l'immunodépression associée aux réponses inflammatoires systémiques / Pathophysiology of Injury-induced Immunosuppression
27 Department of Anesthesiology, Intensive care and Perioperative medicine - Hautepierre Hospital, Strasbourg
28 MSP - Mitochondrie, stress oxydant et protection musculaire
29 UM - Université de Montpellier
30 IMAG - Institut Montpelliérain Alexander Grothendieck
31 Hôtel-Dieu de Nantes
Pierre Asfar
Emmanuel Futier

Résumé

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.
Fichier principal
Vignette du fichier
2021 Jaber et al., Effect of the use.pdf (40.6 Mo) Télécharger le fichier
Origine : Fichiers produits par l'(les) auteur(s)

Dates et versions

hal-03236249 , version 1 (26-05-2021)

Identifiants

Citer

Samir Jaber, Amélie Rollé, Thomas Godet, Nicolas Terzi, Béatrice Riu, et al.. 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. Intensive Care Medicine, In press, ⟨10.1007/s00134-021-06417-y⟩. ⟨hal-03236249⟩
66 Consultations
2 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More