Nasotracheal Intubation With VL vs DL in Infants Trial
- Conditions
- Intubation ComplicationHypoxemiaPediatric HDAnesthesia Intubation ComplicationIntubation; Difficult or FailedHypoxia
- Interventions
- Device: Nasotracheal intubation
- Registration Number
- NCT05433155
- Lead Sponsor
- Children's Hospital of Philadelphia
- Brief Summary
Nasotracheal Intubation with Videolaryngoscopy versus Direct Laryngoscopy in Infants (NasoVISI) Trial is a prospective randomized multicenter study. The study will be conducted at 8 centers in the United States. It is expected that approximately 700 subjects enrolled to product 670 evaluable subjects.The randomization is 1:1 naso tracheal intubation with the Storz C-Mac Video Videolaryngoscopy (VL) or the Standard Direct Laryngoscope (DL). The primary objective is to compare the nasotracheal intubation (NTI) first attempt success rate using VL vs. DL in infants 0-365 days of age presenting for cardiothoracic surgery and cardiac catheterizations.
- Detailed Description
The primary objectives of the study are to compare the nasotracheal intubation (NTI) first attempt success rate using VL vs. DL in infants 0-365 days of age presenting for cardiothoracic surgery and cardiac catheterizations.
Secondary Objectives include the number of attempts for successful intubation; Incidence of failed NTI (conversion to oral intubation); Incidence of failure to intubate with assigned device; Incidence of complications over all attempts including non-severe and severe complications; Incidence of 1st-attempt complications; Need for cricoid pressure or external laryngeal manipulation, need for adjunct- (Magill forceps), rescue of one technique of the other, Percent of glottic opening (POGO) score less than 100%, intubation sequence exceeding 60 seconds and interaction analysis of weight group (i.e. ≤ median weight \& \> median weight (kg)), and by clinicians' experience with cardiac anesthesiology (i.e. Permanent full time team members \& rotating team members) on the association between treatment and outcomes
Study Design: this is a prospective, randomized, multi-center parallel group trial
Setting/Participants: This will be a multi-center study. The target population will be infants 0-365 days of age scheduled for elective cardiothoracic surgery or cardiac catheterization requiring general anesthesia with NTI.
Study Interventions and Measures: The study intervention will be a 1:1 randomization to perform tracheal intubation with the Storz C-Mac Video Videolaryngoscopy (VL) or the Standard Direct Laryngoscope (DL).
Main study outcome measures are as follows:
* The first intubation attempt success rate with each device
* The number of attempts for successful intubation with each device
* Complications associated with intubation
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 680
- Males or females age 0 -365 days
- Scheduled for elective cardiothoracic surgery or cardiac catheterization procedures lasting longer than 30 minutes under general anesthesia where nasotracheal intubation will be performed by an anesthesiology clinician
- Plan to use a neuromuscular blocking drug prior to intubation as standard of care
- Parental/guardian permission (informed consent)
For clinician participants:
- Anesthesia attending, anesthesia fellows, anesthesia resident, Anesthesia Assistant (AA) or CRNA
- Less than 36 weeks gestation
- Less than 2 kg
- History of difficult intubation
- History of abnormal airway
- Predictive of difficult intubation upon physical examination
- Preoperative endotracheal tube or tracheostomy
- Emergency cases
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Videolaryngoscopy Nasotracheal intubation Nasotracheal intubation performed with the Storz C-Mac Video Laryngoscope Direct Laryngoscopy Nasotracheal intubation Nasotracheal Intubation performed with the standard clinical direct blades
- Primary Outcome Measures
Name Time Method VL first attempt success rate 24 hours Direct observation of intubation in the OR and medical record review
- Secondary Outcome Measures
Name Time Method Number of attempts for successful intubation 24 hours Direct observation of intubation in the OR and medical record review
Incidence of failed NTI (conversion to oral intubation) 24 hours Direct observation of intubation in the OR and medical record review
Interaction analysis of weight group and by clinicians' experience with cardiac anesthesiology on the association between treatment and outcomes 24 hours Direct observation of intubation in the OR and medical record review
Incidence of additional techniques 24 hours Direct observation of intubation in the OR and medical record review
Incidence of failure to intubate with assigned device 24 hours Direct observation of intubation in the OR and medical record review
Incidence of complications over all attempts including non-severe and severe complications 24 hours Direct observation of intubation in the OR and medical record review
Incidence of 1st-attempt complications 24 hours Direct observation of intubation in the OR and medical record review
Trial Locations
- Locations (8)
Children's Hospital Colorado
🇺🇸Aurora, Colorado, United States
Children's National Medical Center
🇺🇸Washington, District of Columbia, United States
The Children's Hospital of Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Vanderbilt University Medical Center
🇺🇸Nashville, Tennessee, United States
University of Texas at Austin Dell Children's Medical Center
🇺🇸Austin, Texas, United States
Children's Medical Center Dallas
🇺🇸Dallas, Texas, United States
Texas Children's Hospital
🇺🇸Houston, Texas, United States
Seattle Children's Hospital
🇺🇸Seattle, Washington, United States