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Videolaryngoscopes versus direct laryngoscopes in children: Ranking systematic review with network meta-analyses of

Clístenes C de Carvalho1, Stéphanie L P A Regueira2, Ana Beatriz S Souza3

  • 1Department of Post-Graduation, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.

Paediatric Anaesthesia
|July 6, 2022
PubMed

Insights

Videolaryngoscopes significantly reduce failed tracheal intubation attempts and major complications in children. However, device performance varies, and evidence quality is low, necessitating further research.

Area of Science:

  • Pediatric Anesthesiology
  • Medical Device Technology
  • Clinical Trial Analysis

Background:

  • Videolaryngoscopes enhance tracheal intubation in adults, but their pediatric efficacy remains unclear.
  • This review compares video and direct laryngoscopes for pediatric orotracheal intubation safety and effectiveness.

Purpose of the Study:

  • To systematically review and rank videolaryngoscopes against direct laryngoscopes for pediatric tracheal intubation.
  • To assess efficacy (intubation success rates) and safety (complications, glottic view, intubation time).

Main Methods:

  • A systematic review and meta-analysis of randomized clinical trials in patients aged 18 years or younger.
  • Searched multiple databases, including PubMed, for relevant studies published up to January 27, 2021.
  • Assessed evidence quality using GRADE recommendations.

Main Results:

  • Videolaryngoscopy decreased failed first intubation attempts and failed intubation within two attempts in infants (<1 year).
  • Reduced major complications in infants (<1 year) and overall pediatric population (0-18 years).
  • No significant difference in intubation time; varying performance metrics among videolaryngoscopes; evidence quality is low to very low.

Conclusions:

  • Videolaryngoscopes offer improved safety and efficacy for pediatric tracheal intubation compared to direct laryngoscopy.
  • Further research is needed to identify optimal videolaryngoscope devices for specific pediatric clinical scenarios.
  • Caution is advised when interpreting findings due to the low quality of existing evidence.
Abstract

Keywords:
airway managementlaryngoscopynetwork meta-analysissystematic reviewtracheal intubation

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