Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2012 Jan;59(1):41-52.
doi: 10.1007/s12630-011-9620-5. Epub 2011 Nov 1.

Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis

Donald E G Griesdale  1 , David Liu, James McKinney, Peter T Choi
Affiliations
Meta-Analysis

Glidescope® video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis

Donald E G Griesdale et al. Can J Anaesth. 2012 Jan.

Abstract
in English, French

Introduction: The Glidescope(®) video-laryngoscopy appears to provide better glottic visualization than direct laryngoscopy. However, it remains unclear if it translates into increased success with intubation.

Methods: We systematically searched electronic databases, conference abstracts, and article references. We included trials in humans comparing Glidescope(®) video-laryngoscopy to direct laryngoscopy regarding the glottic view, successful first-attempt intubation, and time to intubation. We generated pooled risk ratios or weighted mean differences across studies. Meta-regression was used to explore heterogeneity based on operator expertise and intubation difficulty.

Results: We included 17 trials with a total of 1,998 patients. The pooled relative risk (RR) of grade 1 laryngoscopy (vs ≥ grade 2) for the Glidescope(®) was 2.0 [95% confidence interval (CI) 1.5 to 2.5]. Significant heterogeneity was partially explained by intubation difficulty using meta-regression analysis (P = 0.003). The pooled RR for nondifficult intubations of grade 1 laryngoscopy (vs ≥ grade 2) was 1.5 (95% CI 1.2 to 1.9), and for difficult intubations it was 3.5 (95% CI 2.3 to 5.5). There was no difference between the Glidescope(®) and the direct laryngoscope regarding successful first-attempt intubation or time to intubation, although there was significant heterogeneity in both of these outcomes. In the two studies examining nonexperts, successful first-attempt intubation (RR 1.8, 95% CI 1.4 to 2.4) and time to intubation (weighted mean difference -43 sec, 95% CI -72 to -14 sec) were improved using the Glidescope(®). These benefits were not seen with experts.

Conclusion: Compared to direct laryngoscopy, Glidescope(®) video-laryngoscopy is associated with improved glottic visualization, particularly in patients with potential or simulated difficult airways.

Introduction: Le vidéolaryngoscope Glidescope® semble procurer une meilleure visualisation de la glotte que la laryngoscopie directe. Il n’est toutefois pas certain que cela se traduise par une meilleure réussite des intubations.

Méthodes: Nous avons fait une recherche systématique dans les bases de données électroniques, parmi les résumés de congrès et les références d’articles. Nous avons inclus les études chez l’homme comparant le vidéolaryngoscope Glidescope® à la laryngoscopie directe pour ce qui concerne la visualisation de la glotte, la réussite de l’intubation au premier essai et le délai d’intubation. Nous avons généré un risque relatif global ou des différences moyennes pondérées entre les études. Une métarégression a permis d’explorer l’hétérogénéité en fonction de l’expertise de l’opérateur et de la difficulté d’intubation.

Résultats: Nous avons inclus 17 études incluant un total de 1998 patients. Le risque relatif (RR) global d’une laryngoscopie de grade 1 (contre une laryngoscopie de grade ≥ 2) avec le Glidescope® a été de 2,0 (intervalle de confiance [IC] à 95 % : 1,5 à 2,5). L’hétérogénéité significative a été expliquée en partie par la difficulté d’intubation en utilisant l’analyse par métarégression (P = 0,003). Le RR global pour les intubations non difficiles de grade 1 à la laryngoscopie (contre les grades ≥ 2) a été de 1,5 (IC à 95 % : 1,2 à 1,9) et le RR pour les intubations difficiles a été de 3,5 (IC à 95 % : 2,3 à 5,5). Il n’y a pas eu de différence entre le Glidescope® et la laryngoscopie directe pour ce qui concerne l’intubation réussie au premier essai ou pour le délai d’intubation, bien qu’une hétérogénéité significative ait été observée pour ces deux critères d’évaluation. Dans les deux études impliquant des non-experts, la première tentative réussie d’intubation (RR: 1,8; IC à 95 % : 1,4 à 2,4) et le délai d’intubation (différence de moyenne pondérée −43 sec; IC à 95 % : −72 à −14 sec) ont été améliorés par l’utilisation du Glidescope®. Ces avantages n’ont pas été retrouvés chez les experts.

Conclusion: Comparée à la laryngoscopie directe, la vidéolaryngoscopie avec le Glidescope® est associée à une amélioration de la visualisation de la glotte, en particulier chez les patients avec des voies aériennes difficiles potentielles ou simulées.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Study selection flow chart
Fig. 2
Fig. 2
Risk ratios (RR) of Cormack-Lehane (CL) grade 1 (vs ≥ grade 2) in clinical trials comparing Glidescope® video-laryngoscopy to direct laryngoscopy stratified by the difficulty of the intubation. Subjects were considered to have difficult intubations in studies that included patients with known prior difficult intubation, physical examination features suggesting difficult intubation, or in which difficult intubation was simulated by providing manual-in-line stabilization. The pooled estimate was derived using the DerSimonian and Laird random effects method with grey squares depicting individual study point estimates of the RR. Larger squares indicate a larger weight of the study when calculating the pooled estimate. Solid horizontal lines display the 95% confidence interval (CI) of the point estimate. Dashed vertical line represents an RR of 1.00, indicating no difference between Glidescope® video-laryngoscopy and direct laryngoscopy. Solid vertical lines represent the pooled estimates. Test for heterogeneity was significant using meta-regression analysis (P = 0.003). DL = direct laryngoscopy; GS = Glidescope®
Fig. 3
Fig. 3
Risk ratios (RR) of successful first-attempt intubation in clinical trials comparing Glidescope® video-laryngoscopy to direct laryngoscopy stratified by operator expertise (anesthesia or casualty consultants or house staff vs “other”). The pooled estimate was derived using the DerSimonian and Laird random effects method with grey squares depicting individual study point estimates of the RR. Larger squares indicate a larger weight of the study when calculating the pooled estimate. Solid horizontal lines display the 95% CI of the point estimate. Dashed vertical line represents an RR of 1.00, indicating no difference between Glidescope® video-laryngoscopy and direct laryngoscopy. Solid vertical lines represent the pooled estimates. Test for heterogeneity by operator expertise was significant using meta-regression analysis (P = 0.001). DL = direct laryngoscopy; GS = Glidescope®
Fig. 4
Fig. 4
Weighted mean difference (WMD), in seconds, in clinical trials comparing Glidescope® video-laryngoscopy to direct laryngoscopy stratified by operator expertise (anesthesia or casualty consultants or housestaff vs “other”). The pooled estimate was derived using the DerSimonian and Laird random effects method with grey squares depicting an individual study point estimate of the mean difference. Larger squares indicate a larger weight of the study when calculating the pooled estimate. Solid horizontal lines display the 95% CI of the point estimate. Dashed vertical line represents a WMD of 0, indicating no difference between Glidescope® video-laryngoscopy and direct laryngoscopy. Solid vertical lines represent the pooled estimate. Test for heterogeneity by operator expertise was significant using meta-regression analysis (P = 0.004)
See this image and copyright information in PMC

References

    1. Cheney FW, Posner KL, Lee LA, Caplan RA, Domino KB. Trends in anesthesia-related death and brain damage: a closed claims analysis. Anesthesiology. 2006;105:1081–1086. doi: 10.1097/00000542-200612000-00007. - DOI - PubMed
    1. Rose DK, Cohen MM. The incidence of airway problems depends on the definition used. Can J Anaesth. 1996;43:30–34. doi: 10.1007/BF03015954. - DOI - PubMed
    1. Ezri T, Weisenberg M, Khazin V, et al. Difficult laryngoscopy: incidence and predictors in patients undergoing coronary artery bypass surgery versus general surgery patients. J Cardiothorac Vasc Anesth. 2003;17:321–324. doi: 10.1016/S1053-0770(03)00052-1. - DOI - PubMed
    1. el-Ganzouri AR, McCarthy RJ, Tuman KJ, Tanck EN, Ivankovich AD. Preoperative airway assessment: predictive value of a multivariate risk index. Anesth Analg. 1996;82:1197–1204. - PubMed
    1. Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth. 1998;45:757–776. doi: 10.1007/BF03012147. - DOI - PubMed

LinkOut - more resources