Chest
Volume 152, Issue 3, September 2017, Pages 510-517
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Original Research: Critical Care
Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis

https://doi.org/10.1016/j.chest.2017.06.012Get rights and content

Background

Endotracheal intubation (EI) in ICU patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in the expertise of operators. The goal of this study was to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI.

Methods

We searched for relevant studies in PubMed, Embase, and the Cochrane database from inception through January 30, 2017. Randomized controlled trials were included if they reported data on any of the predefined outcomes in ICU patients requiring EI and managed with VL or DL. Results were expressed as risk ratios (RRs) or mean differences (MDs) with accompanying 95% CIs.

Results

Five randomized controlled trials with 1,301 patients were included. Despite better glottic visualization with VL (RR = 1.24; 95% CI, 1.07 to 1.43; P = .003), use of VL did not result in a significant increase in the first-attempt success rate (RR = 1.08; 95% CI, 0.92-1.26; P = .35) compared with DL. In addition, time to intubation (MD = 4.12 s; 95% CI, –15.86-24.09; P = .69), difficult intubation (RR = 0.72; 95% CI, 0.30-1.70; P = .45), mortality (RR = 1.02; 95% CI, 0.84-1.25; P = .83), and most other complications were similar between the VL and DL groups.

Conclusions

The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.

Section snippets

Search Strategy and Selection Criteria

This systematic review and meta-analysis was conducted in accordance with the protocol specified in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.14 We searched RCTs in the PubMed, Embase, and Cochrane databases from inception through January 30, 2017, to identify potentially relevant studies. Search terms included: “videotape recording” OR “video-laryngoscope” OR “video laryngoscopy” OR “video recording” OR “laryngoscopes” AND “critically ill” OR “intensive

Trial Identification and Characteristics

The literature search yielded 382 records through database searching, and five RCTs fulfilling inclusion criteria were eligible for final analysis.7, 8, 12, 13, 17 The overview of the study selection process is presented in Figure 1. The Cochrane risk of bias score varied across these studies (e-Figs 1 and 2). The main characteristics of included studies and predefined outcomes are shown in Tables 1 and 2, respectively, and the definitions of operator experience and first-pass success during

Discussion

In the current meta-analysis, we compared the use of VL with the DL technique in critically ill patients requiring EI. Despite better glottic visualization, use of VL did not increase the first-attempt success rate during EI. In addition, there were no differences between the VL and DL groups in terms of the secondary outcomes, such as time to intubation, difficult intubation, and mortality rate. Our results are in contrast with the findings of a previous meta-analysis,6 which showed that,

Conclusions

VL did not improve the first-pass success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL during EI.

Acknowledgments

Author contributions: H.-B. H. contributed to the conception of the study, data collection, analysis, and drafting of the article. J.-M. P. contributed to data collection, literature search, and writing of the manuscript. B. X. and G.-Y. L. contributed to data collection and analysis. B. D. contributed to the study concept and design, data analysis and interpretation, drafting and revision of the manuscript, and final approval of the manuscript.

Financial/nonfinancial disclosures: None declared.

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    FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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