{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:31:41Z","timestamp":1789605101141,"version":"build-2803163510"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2017,3,1]],"date-time":"2017-03-01T00:00:00Z","timestamp":1488326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Video laryngoscopy has overcome the need to align the anatomic axes to obtain a view of the glottic opening to place a tracheal tube. However, despite this advantage, a large number of attempts are unsuccessful. There are no existing data on anatomic characteristics in critically ill patients associated with a failed first attempt at laryngoscopy when using video laryngoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify characteristics associated with first-attempt failure at intubation when using video laryngoscopy in the intensive care unit (ICU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is an observational study of 906 consecutive patients intubated in the ICU with a video laryngoscope between January 2012 and January 2016 in a single-center academic medical ICU. After each intubation, the operator completed a data collection form, which included information on difficult airway characteristics, device used, and outcome of each attempt. Multivariable regression models were constructed to determine the difficult airway characteristics associated with a failed first attempt at intubation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>There were no significant differences in sex, age, reason for intubation, or device used between first-attempt failures and first-attempt successes. First-attempt successes more commonly reported no difficult airway characteristics were present (23.9%; 95% confidence interval [CI], 20.7\u201327.0% vs. 13.3%; 95% CI, 8.0\u201318.8%). In logistic regression analysis of the entire 906-patient database, blood in the airway (odds ratio [OR], 2.63; 95% CI, 1.64\u20134.20), airway edema (OR, 2.85; 95% CI, 1.48\u20135.45), and obesity (OR, 1.59; 95% CI, 1.08\u20132.32) were significantly associated with first-attempt failure. Data collection on limited mouth opening and secretions began after the first 133 intubations, and we fit a second logistic model to examine cases in which these additional difficult airway characteristics were collected. In this subset (n\u2009=\u2009773), the presence of blood (OR, 2.73; 95% CI, 1.60\u20134.64), cervical immobility (OR, 3.34; 95% CI, 1.28\u20138.72), and airway edema (OR, 3.10; 95% CI, 1.42\u20136.70) were associated with first-attempt failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single-center study, presence of blood in the airway, airway edema, cervical immobility, and obesity are associated with higher odds of first-attempt failure, when intubation was performed with video laryngoscopy in an ICU.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.201606-472oc","type":"journal-article","created":{"date-parts":[[2017,3,1]],"date-time":"2017-03-01T15:21:06Z","timestamp":1488381666000},"page":"368-375","source":"Crossref","is-referenced-by-count":43,"title":["Difficult Airway Characteristics Associated with First-Attempt Failure at Intubation Using Video Laryngoscopy in the Intensive Care Unit"],"prefix":"10.1093","volume":"14","author":[{"given":"Raj","family":"Joshi","sequence":"first","affiliation":[{"name":"Section of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and"},{"name":"Department of Emergency Medicine, University of Arizona, Tucson, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron D.","family":"Hypes","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and"},{"name":"Department of Emergency Medicine, University of Arizona, Tucson, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and"},{"name":"Department of Emergency Medicine, University of Arizona, Tucson, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Snyder","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Malo","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"Bloom","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and"},{"name":"University of Arizona College of Medicine, Tucson, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harsharon","family":"Chopra","sequence":"additional","affiliation":[{"name":"University of Arizona College of Medicine, Tucson, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Sakles","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Arizona, Tucson, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5371-0845","authenticated-orcid":false,"given":"Jarrod M.","family":"Mosier","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, and"},{"name":"Department of Emergency Medicine, University of Arizona, Tucson, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,3,1]]},"reference":[{"key":"2026020403053520800_bib1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/00000542-199502000-00007","article-title":"Death and other complications of emergency airway management in critically ill adults: a prospective 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