Comparison Of Videolaryngoscopy And direct laRyngoscopy for pedIatric oro-trAcheal iNTubation in an oncology ICU (COVARIANT): A Randomized Controlled Trial

The airway anatomy of the childrenis distinctive as compared with adults. The laryngoscopy and intubation inchildren are difficult because of restricted opening of the mouth,comparatively larger tongue and more cephalad larynx; also, the consumption ofoxygen is much higher in children as compared to the adults. Hence, limitedperiod is available for the intubation in children(1).The presence ofcongenital orofacial clefts distort the upper airway anatomy and associationwith wider palatal clefts, bilateral cleft lips, major nasal deformity, micrognathiaand receding mandible also increases the intubation difficulty.(2)

Particularly in cancer patient with pneumonia,radiation exposure, anterior mediastinal mass, orofacial tumors, bleedingtendency, distorted airway will further reduce the time window and increasedifficulty in tracheal intubation.

In VL, the scope incorporatesan integrated camera and display monitor, which is used for indirectlaryngoscopy to view the airway structures Since the view is obtained “around thecorner†the glottis is visualized better by the VL. A lesser quantity of forceis required at the base of the tongue during VL. Hence, the chances of localtissue injury and response to stress are reduced. Even though there is limited evidencethat the success of endotracheal intubation (ETI) is increased by VL, VL is nowmore.(3)

Since there are no comparative ICU studiesavailable for pediatric population, we decided to conduct this study.