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Updated: Dec 8, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department
Thomaz Bittencourt Couto1, Amélia Gorete Reis, Sylvia Costa Lima Farhat
1Instituto da Criança do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
Insights
Video laryngoscopy significantly improves first-attempt tracheal intubation success in children over one year old compared to direct laryngoscopy. This method also reduces associated adverse events during pediatric intubation procedures.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Critical Care
Background:
- Tracheal intubation is a critical procedure in pediatric emergency care.
- Direct laryngoscopy (DL) has limitations in achieving successful first-attempt intubation.
- Video laryngoscopy (VL) offers a potential alternative for improving intubation outcomes.
Purpose of the Study:
- To compare the first-attempt success rate of tracheal intubation using video laryngoscopy versus direct laryngoscopy in pediatric patients.
- To evaluate the frequency of intubation-associated events and desaturation between the two methods.
- To assess the impact of video laryngoscope use on intubation attempts and outcomes.
Main Methods:
- Prospective observational cohort study in an academic pediatric tertiary emergency department.
- Comparison of 50 children intubated with a video laryngoscope (Mcgrath Mac) versus 141 historical controls intubated with direct laryngoscopy.
- Patients aged 1 to 18 years undergoing tracheal intubation.
Main Results:
- First-attempt intubation success was significantly higher with video laryngoscopy (68%) compared to direct laryngoscopy (37.6%) (P < .01).
- Tracheal intubation-associated events were lower in the video laryngoscopy group (31.3%) versus the direct laryngoscopy group (67.8%) (P < .01).
- Median intubation attempts were lower with VL (1) compared to DL (2) (P < .01), with no significant difference in desaturation rates.
Conclusions:
- Video laryngoscopy is associated with higher first-attempt tracheal intubation success rates in pediatric patients over one year old.
- The use of video laryngoscopy leads to a reduction in tracheal intubation-associated events compared to direct laryngoscopy.
- Video laryngoscopy represents an effective advancement for improving airway management in pediatric emergency settings.
Abstract:
The aim of this study was to compare the success of first-attempt tracheal intubation in pediatric patients >1-year old performed using video versus direct laryngoscopy and compare the frequency of tracheal intubation-associated events and desaturation among these patients.Prospective observational cohort study conducted in an Academic pediatric tertiary emergency department. We compared 50 children intubated with Mcgrath Mac video laryngoscope (VL group) and an historical series of 141 children intubated with direct laryngoscopy (DL group). All patients were aged 1 to 18 years.The first attempt success rates were 68% (34/50) and 37.6% (53/141) in the VL and DL groups (P < .01), respectively. There was a lower proportion of tracheal intubation-associated events in the VL group (VL, 31.3% [15/50] vs DL, 67.8% [97/141]; P < .01) and no significant differences in desaturation (VL, 35% [14/50] vs DL 51.8% [72/141]; P = .06). The median number of attempts was 1 (range, 1-5) for the VL group and 2 (range, 1-8) for the DL group (P < .01). Multivariate logistic regression showed that video laryngoscope use was associated with higher chances of first-attempt intubation with an odds ratio of 4.5 (95% confidence interval, 1.9-10.4, P < 0.01).Compared with direct laryngoscopy, VL was associated with higher success rates of first-attempt tracheal intubations and lower rates of tracheal intubation-associated events.
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