Macintosh Blade Size for Endotracheal Intubation in Operative Rooms

NCT ID: NCT06232837

Last Updated: 2026-02-02

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 3058 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2024-01-22
• Study Completion Date: 2025-09-20

Brief Summary

Endotracheal intubation is a frequent procedure in the operating room but optimal Macintosh blade size remains unknown to date.

Detailed Description

Endotracheal intubation is an extremely frequent procedure in the operating room, in intensive care units and in emergency medicine (in- or out-of-hospital). Apart from special cases of foreseen difficult programmed intubation, direct laryngoscopy remains the most frequently used technique. It requires the use of a handle (short or long), which serves as a light source on which is adapted a Macintosh curved blade, metallic or plastic, single or multiple use. The choice of blade size is based on the experience of the physician. Most often, in adult settings, size 3 or 4 blades are used. The very spartan literature on the subject and the current recommendations do not provide any information on the choice of blade size. Our team (and others) recently concluded that intubation first attempt rates in intensive care units or emergency settings were improved when using shorter Macintosh blade size No3 vs 4 (Godet et al. Intensive Care Medicine 2022 and Landefeld et al. Critical Care Explorations 2023). We therefore wish to evaluate these practices in terms of success of the first laryngoscopy, Cormack-Lehane and POGO (percentage of glottic opening visualized) scores, the need to use an alternative technique or a second operator in operative rooms. The results will be analyzed with regard as a function and experience of the person performing the laryngoscopy, as well as the setting (urgent or scheduled). These data are usually collected during the performance of an endotracheal intubation in a nationwide fashion in French operative rooms.

Conditions

Intubation Complication; Intubation; Difficult or Failed; Endotracheal Intubation

Study Design

• Observational Model Type: CASE_CONTROL
• Study Time Perspective: PROSPECTIVE

Study Groups

Macintosh blade size 3

Patients intubated using Macintosh blade size 3

Direct laryngoscopy using Macintosh blade

Intervention Type: DEVICE

Patients in operative room requiring direct laryngoscopy for endotracheal intubation

Macintosh blade size 4

Patients intubated using Macintosh blade size 4

Direct laryngoscopy using Macintosh blade

Intervention Type: DEVICE

Patients in operative room requiring direct laryngoscopy for endotracheal intubation

Interventions

Direct laryngoscopy using Macintosh blade

Patients in operative room requiring direct laryngoscopy for endotracheal intubation

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Patients must be admitted in a participating operative room and require mechanical ventilation through an orotracheal tube.
• Adult (age ≥ 18 years)
• Subjects must be covered by public health insurance
• Written informed consent from the patient or proxy (if present) before inclusion or once possible when patient has been included in a context of emergency.

Exclusion Criteria

• Anticipated difficult intubation requiring videolaryngoscopy or other technic in first place
• Nasotracheal intubation
• Refusal of study participation or to pursue the study by the patient
• Absence of coverage by the French statutory healthcare insurance system
• Protected person

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Société Française d'Anesthésie-Réanimation (SFAR)

UNKNOWN

Sponsor Role: collaborator

University Hospital, Clermont-Ferrand

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Thomas Godet, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Clermont-Ferrand University Hospitals

Locations

CHU Clermont-Ferrand

Clermont-Ferrand, , France

Countries

France

References

Godet T, De Jong A, Garin C, Guerin R, Rieu B, Borao L, Pereira B, Molinari N, Bazin JE, Jabaudon M, Chanques G, Futier E, Jaber S. Impact of Macintosh blade size on endotracheal intubation success in intensive care units: a retrospective multicenter observational MacSize-ICU study. Intensive Care Med. 2022 Sep;48(9):1176-1184. doi: 10.1007/s00134-022-06832-9. Epub 2022 Aug 16.

Reference Type: BACKGROUND

PMID: 35974189 (View on PubMed)

Landefeld KR, Koike S, Ran R, Semler MW, Barnes C, Stempek SB, Janz DR, Rice TW, Russell DW, Self WH, Vonderhaar D, West JR, Casey JD, Khan A. Effect of Laryngoscope Blade Size on First Pass Success of Tracheal Intubation in Critically Ill Adults. Crit Care Explor. 2023 Mar 6;5(3):e0855. doi: 10.1097/CCE.0000000000000855. eCollection 2023 Mar.

Reference Type: BACKGROUND

PMID: 36895888 (View on PubMed)

Other Identifiers

IRB 00010254-2023-081

Identifier Type: -

Identifier Source: org_study_id