Critical Care Medicine 52(11):p
1674-1685, November 2024.
OBJECTIVES:
Given the uncertainty regarding the optimal approach to
laryngoscopy for the intubation of critically ill adult patients, we conducted
a systematic review and meta-analysis to compare video laryngoscopy (VL) vs.
direct laryngoscopy (DL) for intubation in emergency department and ICU
patients.
DATA SOURCES:
We searched MEDLINE, PubMed, Embase, Cochrane Library, and
unpublished sources, from inception to February 27, 2024.
STUDY SELECTION:
We included randomized controlled trials (RCTs) of
critically ill adult patients randomized to VL compared with DL for
endotracheal intubation.
DATA EXTRACTION:
Reviewers screened abstracts, full texts, and extracted data
independently and in duplicate. We pooled data using a random-effects model,
assessed risk of bias using the modified Cochrane tool and certainty of
evidence using the Grading Recommendations Assessment, Development, and
Evaluation approach. We pre-registered the protocol on PROSPERO
(CRD42023469945).
DATA SYNTHESIS:
We included 20 RCTs (n = 4569 patients).
Compared with DL, VL probably increases first pass success (FPS) (relative risk
[RR], 1.13; 95% CI, 1.06–1.21; moderate certainty) and probably decreases
esophageal intubations (RR, 0.47; 95% CI, 0.27–0.82; moderate certainty). VL
may result in fewer aspiration events (RR, 0.74; 95% CI, 0.51–1.09; low
certainty) and dental injuries (RR, 0.46; 95% CI, 0.19–1.11; low certainty) and
may have no effect on mortality (RR, 0.97; 95% CI, 0.88–1.07; low certainty)
compared with DL.
CONCLUSIONS:
In critically ill adult patients undergoing intubation, the
use of VL, compared with DL, probably leads to higher rates of FPS and probably
decreases esophageal intubations. VL may result in fewer dental injuries as
well as aspiration events compared with DL with no effect on mortality.
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