Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Sep;48(9):1176-1184.
doi: 10.1007/s00134-022-06832-9. Epub 2022 Aug 16.

Impact of Macintosh blade size on endotracheal intubation success in intensive care units: a retrospective multicenter observational MacSize-ICU study

Thomas Godet  1   2   3 , Audrey De Jong  4 , Côme Garin  5 , Renaud Guérin  5 , Benjamin Rieu  5 , Lucile Borao  5 , Bruno Pereira  6 , Nicolas Molinari  7 , Jean-Etienne Bazin  5 , Matthieu Jabaudon  5   8 , Gérald Chanques  4 , Emmanuel Futier  5   8 , Samir Jaber  4
Affiliations
Observational Study

Impact of Macintosh blade size on endotracheal intubation success in intensive care units: a retrospective multicenter observational MacSize-ICU study

Thomas Godet et al. Intensive Care Med. 2022 Sep.

Abstract

Purpose: To investigate the impact of Macintosh blade size used during direct laryngoscopy (DL) on first-attempt intubation success of orotracheal intubation in French intensive care units (ICUs). We hypothesized that success rate would be higher with Macintosh blade size No3 than with No4.

Methods: Multicenter retrospective observational study based on data from prospective trials conducted in 48 French ICUs of university, and general and private hospitals. After each intubation using Macintosh DL, patients' and operators' characteristics, Macintosh blade size, results of first DL and alternative techniques used, as well as the need of a second operator were collected. Complications rates associated with intubation were investigated. Primary outcome was success rate of first DL using Macintosh blade.

Results: A total of 2139 intubations were collected, 629 with a Macintosh blade No3 and 1510 with a No4. Incidence of first-pass intubation after first DL was significantly higher with Macintosh blade No3 (79.5 vs 73.3%, p = 0.0025), despite equivalent Cormack-Lehane scores (p = 0.48). Complications rates were equivalent between groups. Multivariate analysis concluded to a significant impact of Macintosh blade size on first DL success in favor of blade No3 (OR 1.44 [95% CI 1.14-1.84]; p = 0.0025) without any significant center effect on the primary outcome (p = 0.18). Propensity scores and adjustment analyses concluded to equivalent results.

Conclusion: In the present study, Macintosh blade No3 was associated with improved first-passed DL in French ICUs. However, study design requires the conduct of a nationwide prospective multicenter randomized trial in different settings to confirm these results.

Keywords: Complications; Intensive care unit; Intubation; Laryngoscopy; Macintosh blade.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest related to the present work.

Figures

Fig. 1
Fig. 1
Flowchart of included patients
Fig. 2
Fig. 2
Results of first-attempt direct laryngoscopy and intubation success rates, and glottic view according to Cormack–Lehane score
Fig. 3
Fig. 3
Complications rates of intubation according to Macintosh blade size. Moderate complications include esophageal intubation, tooth injury, operator reported aspiration, laryngeal injury, agitation, and cardiac arrhythmia. Severe complications include hypoxemia, cardiovascular collapse, cardiac arrest, and death related to intubation
See this image and copyright information in PMC

Comment in

  • Size does matter.
    Geboers DGPJ, Gigengack RK, Zijlstra GJ. Geboers DGPJ, et al. Intensive Care Med. 2023 Feb;49(2):266. doi: 10.1007/s00134-022-06931-7. Epub 2022 Nov 24. Intensive Care Med. 2023. PMID: 36434101 No abstract available.

References

    1. De Jong A, Molinari N, Terzi N, Mongardon N, Arnal JM, Guitton C, Allaouchiche B, Paugam-Burtz C, Constantin JM, Lefrant JY, Leone M, Papazian L, Asehnoune K, Maziers N, Azoulay E, Pradel G, Jung B, Jaber S, AzuRea Network for the Frida-Rea Study Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med. 2013;187:832–839. - PubMed
    1. Quintard H, l’Her E, Pottecher J, Adnet F, Constantin JM, De Jong A, Diemunsch P, Fesseau R, Freynet A, Girault C, Guitton C, Hamonic Y, Maury E, Mekontso-Dessap A, Michel F, Nolent P, Perbet S, Prat G, Roquilly A, Tazarourte K, Terzi N, Thille AW, Alves M, Gayat E, Donetti L. Intubation and extubation of the ICU patient. Anaesth Crit Care Pain Med. 2017;36:327–341. - PubMed
    1. Higgs A, McGrath BA, Goddard C, Rangasami J, Suntharalingam G, Gale R, Cook TM, Society DA, Society IC, Medicine FoIC, Anaesthetists RCo Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120:323–352. - PubMed
    1. De Jong A, Rolle A, Pensier J, Capdevila M, Jaber S. First-attempt success is associated with fewer complications related to intubation in the intensive care unit. Intensive Care Med. 2020;46:1278–1280. - PubMed
    1. Jaber S, Rollé A, Godet T, Terzi N, Riu B, Asfar P, Bourenne J, Ramin S, Lemiale V, Quenot JP, Guitton C, Prudhomme E, Quemeneur C, Blondonnet R, Biais M, Muller L, Ouattara A, Ferrandiere M, Saint-Léger P, Rimmelé T, Pottecher J, Chanques G, Belafia F, Chauveton C, Huguet H, Asehnoune K, Futier E, Azoulay E, Molinari N, De Jong A, group St 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 Med. 2021;47:653–664. - PMC - PubMed

Publication types

LinkOut - more resources