Interventions
’s mouth, critically ill
EVENT, CRITICALLY ILL
The preparations for induction of anaesthesia as well as establishing the necessary patient monitoring will take place in accordance with the stipulations of the anaesthetist in charge and with local standards. Randomization will take place electronically on the day of the intervention; the randomization result is communicated to the team performing the intervention (i.e. anaesthetist and anaesthesia nurse) in such a way that the patient is unaware of it. The study protocol does not specify the manufacturer or model of the laryngoscope to be used (e.g., disposable vs. reusable blades). However, the kind of blade will be recorded, as previous research suggested considerably reduced glottic view with (disposable) plastic blades compared with metal blades [The choice and dosage of the anaesthetics as well as the sequence of administration is up to the decision of the anaesthetist in charge. For better comparability between the interventions, adequate pre-oxygenation (etO2 > 80%) and relaxation of the patient (ideally, train of four (TOF) = 0) is required before starting the laryngoscopy. The process of laryngoscopy (and thus also the first attempt at intubation) begins when the blade of the laryngoscope passes the patient’s row of teeth for the first time. The trial observer will also start the time measurement for the intubation procedure at this timepoint. The intubation is considered to have been completed successfully when the first capnographic end-expiratory CO2 detection is possible after the endotracheal tube has been placed. In the event of failure, the first attempt at intubation is deemed to have ended at the point in time when either the laryngoscope (e.g., after inadequate visibility of the vocal cords) or the endotracheal tube is removed from the patient’s mouth. Each additional intubation attempt using the same criteria should be considered a completed attempt.The use of an intubation stylet is not primarily intended; the exception here is the use of a hyper-angulated blade, which cannot be used properly without a stylet. The routine use of a stylet for every endotracheal intubation is discussed in the literature in the context of critically ill patients [After completion of the intervention, both the nurse and the anaesthetist in charge will answer the MHPTS questionnaire and the NASA-TLX questionnaire. To ensure that no necessary medical measures are delayed or hindered under any circumstances will be of the essence.