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. 2023 Jun 9:10:1193514.
doi: 10.3389/fmed.2023.1193514. eCollection 2023.

Comparison of video laryngoscopy with direct laryngoscopy for intubation success in critically ill patients: a systematic review and Bayesian network meta-analysis

Jae Guk Kim #  1 , Chiwon Ahn #  2 , Wonhee Kim  1 , Tae-Ho Lim  3 , Bo-Hyong Jang  4 , Youngsuk Cho  5 , Hyungoo Shin  3 , Heekyung Lee  3 , Juncheol Lee  3 , Kyu-Sun Choi  6 , Min Kyun Na  6 , Sae Min Kwon  7
Affiliations

Comparison of video laryngoscopy with direct laryngoscopy for intubation success in critically ill patients: a systematic review and Bayesian network meta-analysis

Jae Guk Kim et al. Front Med (Lausanne). .

Abstract

Introduction: This review compares the efficacy of video laryngoscopy (VL) with direct laryngoscopy (DL) for successful tracheal intubation in critically ill or emergency-care patients.

Methods: We searched the MEDLINE, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) that compared one or more video laryngoscopes to DL. Sensitivity analysis, subgroup analysis, and network meta-analysis were used to investigate factors potentially influencing the efficacy of VL. The primary outcome was the success rate of first-attempt intubation.

Results: This meta-analysis included 4244 patients from 22 RCTs. After sensitivity analysis, the pooled analysis revealed no significant difference in the success rate between VL and DL (VL vs. DL, 77.3% vs. 75.3%, respectively; OR, 1.36; 95% CI, 0.84-2.20; I2 = 80%; low-quality evidence). However, based on a moderate certainty of evidence, VL outperformed DL in the subgroup analyses of intubation associated with difficult airways, inexperienced practitioners, or in-hospital settings. In the network meta-analysis comparing VL blade types, nonchanneled angular VL provided the best outcomes. The nonchanneled Macintosh video laryngoscope ranked second, and DL ranked third. Channeled VL was associated with the worst treatment outcomes.

Discussion: This pooled analysis found, with a low certainty of evidence, that VL does not improve intubation success relative to DL. Channeled VL had low efficacy in terms of intubation success compared with nonchanneled VL and DL.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285702, identifier: CRD42021285702.

Keywords: critical care; intubation; laryngoscopy; network meta-analysis; randomized controlled trial.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart depicting the disposition and selection of articles included in this systematic review and meta-analysis.
Figure 2
Figure 2
Forest plot depicting the subgroup analysis for (A) study design and (B) difficult airway.
Figure 3
Figure 3
Network map (A) and forest plot (B) of the network meta-analysis of first-attempt intubation success.
See this image and copyright information in PMC

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