Hyperangulated Versus Standard Geometry Laryngoscope Blade Trial

The Hyperangulated versus Standard Geometry Laryngoscope Blade (ANGLE) Trial is a multi-center, non-blinded, parallel-group, randomized clinical trial evaluating the effect of use of a hyperangulated video laryngoscope blade versus use of a standard geometry video laryngoscope blade. Critically ill adults undergoing tracheal intubation in participating EDs and ICUs who meet eligibility criteria will be enrolled and randomly assigned in a 1:1 ratio to either intubation using a hyperangulated video laryngoscope blade or a standard geometry video laryngoscope blade. The primary outcome is the incidence of successful intubation on the first attempt. The secondary outcome is incidence of hypoxemia during the interval between induction and 2 minutes after tracheal intubation.

Inclusion Criteria 1. Patient is located in a participating unit. 2. Planned procedure is orotracheal intubation using a laryngoscope. 3. Planned operator is a clinician expected to routinely perform tracheal intubation in the participating unit. Exclusion Criteria: 1. Patient is known to be less than 18 years old. 2. Patient is known to be pregnant. 3. Patient is known to be a prisoner. 4. Immediate need for tracheal intubation precludes safe performance of study procedures. 5. Operator has determined that use of a direct laryngoscope is required for the optimal care of the patient. 6. Operator has determined that use of a hyperangulated video laryngoscope blade or a standard geometry video laryngoscope blade is required or contraindicated for the optimal care of the patient either because of factors related to the patient (e.g., patient's upper airway anatomy requires a specific blade type) or the operator (e.g., treating clinicians lack sufficient comfort with one of the blade types).