Nasotracheal Intubation with Videolaryngoscopy versus Direct Laryngoscopy in Infants (NasoVISI) Trial

Complications related to infant (< 1 year) airway management are under-appreciated because of few rigorous and targeted studies. We have recently shown that multiple tracheal intubation (TI) attempts are a key risk factor for intubation-related complications in small children. TI using Video laryngoscopy (VL) has become popular in anesthesiology practice because of several advantages over conventional direct laryngoscopy (DL). Studies show that VL improves the view of the airway compared to DL, requires fewer intubation attempts, but may take more time to intubate the trachea. Our recently published international multicenter clinical trial in healthy infants requiring orotracheal intubation demonstrated that using VL compared to DL was associated with a greater first attempt success rate and fewer severe complications. Infants presenting for cardiac procedures, many with cardiopulmonary bypass, commonly have nasotracheal intubation performed. It is unknown if VL is superior to DL when performing nasotracheal intubations.