Videolaryngoscopy versus direct laryngoscopy for tracheal intubation by anesthesia residents in the operating room: The randomized multicenter VILARE trial protocol

Abstract

Introduction

Tracheal intubation using direct laryngoscopy with a Macintosh blade remains the standard technique in the operating room. However, this method requires precise anatomical alignment and direct visualization of the glottis, which can be challenging for anesthesia residents with limited experience. Multiple intubation attempts are associated with an increased risk of complications. Videolaryngoscopy allows indirect visualization of the glottis and enables real-time supervision and feedback during the procedure, potentially improving safety and facilitating learning. Although videolaryngoscopy has shown benefits in difficult airway scenarios and in experienced hands, evidence is limited on whether it improves first-pass success and reduces complications when used by anesthesia residents in patients without predicted airway difficulty. The aim of this study is to compare first-pass intubation success with videolaryngoscopy versus direct laryngoscopy when performed by anesthesia residents in the operating room.

Methods and analysis

The VILARE trial is a prospective, multicenter, randomized, open-label study. A total of 1008 adult patients undergoing elective or urgent surgery under general anesthesia, without predictors of difficult airway, will be randomized to undergo tracheal intubation using either a standard Macintosh direct laryngoscope or a Macintosh videolaryngoscope on the first attempt. All tracheal intubations will be performed by anesthesia residents. The primary endpoint is successful intubation on the first attempt. Secondary outcomes time for successful tracheal intubation, attempts for successful intubation, laryngoscopic vision with the modified Cormack-Lehane scale, need of adjuvant airway devices for intubation, subjective difficulty of intubation, and complications during tracheal intubation (e.g., desaturation, dental trauma).

Ethics and dissemination

The study protocol was approved November 28, 2024, by the Ethics Committee of Galicia, Spain (CEI-SL, code No. 2024/394).and was registered into the Clinicaltrials.gov clinical trials registry with No. NCT06842082. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If videolaryngoscopy improves first-attempt intubation success and reduces complications in anesthesia residents, its use may be recommended as the first-line device in anesthesia training programs.

Trial registration number

ClinicalTrials.gov Registry: NCT06842082.