Facilitating EndotracheaL Intubation by Laryngoscopy Technique and Apneic Oxygenation Within the Intensive Care Unit: The FELLOW Study

Respiratory failure requiring endotracheal intubation occurs in as many as 40% of critically
ill patients. Procedural complications including failed attempts at intubation, esophageal
intubation, arterial oxygen desaturation, aspiration, hypotension, cardiac arrest, and death
are common in this setting. While there are many important components of successful airway
management in critical illness, the maintenance of adequate arterial hemoglobin saturation
from procedure initiation until endotracheal tube placement is paramount as desaturation is
the most common factor associated with peri-intubation cardiac arrest and death.
Interventions that either shorten the duration of time required for tube placement or
prolong the period before desaturation may be effective in improving outcome. The high rate
of complications and the lack of existing evidence regarding the efficacy of current airway
management techniques in shortening the time to airway establishment or prolonging the time
to desaturation mandates further investigation. The primary hypothesis is that video
laryngoscopy will be superior to direct laryngoscopy in successful first attempt at
endotracheal intubation (defined by confirmed placement of an endotracheal tube in the
trachea during first laryngoscopy attempt) of medical ICU patients by Pulmonary/Critical
Care Medicine fellows after controlling for the operator's past number of procedures with
the equipment used. Also, the investigators hypothesize that the provision of apneic
oxygenation during the endotracheal intubation procedure (defined as a nasal cannula with 15
liters per minute of oxygen flow placed prior to sedation or neuromuscular blockade and
maintained until after completion of the procedure) will result in a higher arterial oxygen
saturation nadir (defined as lowest noninvasive oxygenation saturation value observed
between the administration of sedation and/or neuromuscular blockade and 2 minutes after
successfully secured airway or death) compared to no apneic oxygenation.