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Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network

Hiroshi Hoshijima1, Takahiro Mihara2, Shinichi Kokubu3

  • 1Division of Dento-Oral Anesthesiology, Graduate School of Dentistry, Tohoku University, Sendai 980-8575, Japan.

Children (Basel, Switzerland)
|September 23, 2022
PubMed

Insights

Network meta-analysis ranked pediatric intubation devices. No device surpassed the Macintosh laryngoscope for first-attempt intubation success or glottic visualization in children.

Area of Science:

  • Pediatric Anesthesiology
  • Medical Device Technology
  • Clinical Effectiveness Research

Background:

  • Effective tracheal intubation is critical in pediatric care.
  • Varied intubation devices exist, but comparative effectiveness data is limited.
  • Ranking device performance is essential for clinical decision-making.

Purpose of the Study:

  • To systematically rank the effectiveness of various tracheal intubation devices in pediatric patients.
  • To compare first-attempt intubation failure rates, glottic visualization, and intubation times.
  • To utilize network meta-analysis (NMA) for a comprehensive effectiveness assessment.

Main Methods:

  • A systematic search of electronic databases for prospective randomized trials comparing pediatric tracheal intubation devices.
  • Network meta-analysis (NMA) using DerSimonian and Laird random-effects models.
  • Evaluation of primary outcome (first-attempt intubation failure) and secondary outcomes (glottic visualization, intubation time).

Main Results:

  • Thirty-four trials involving 13 devices were analyzed.
  • Most devices showed similar first-attempt intubation failure rates to the Macintosh laryngoscope.
  • The Truview PCD™ demonstrated a significantly higher failure rate; Airtaq™, AirwayScope™, McGrath™, and Truview EVO2™ ranked higher than Macintosh. Bullard™ ranked lowest.
  • Glottic visualization was comparable across devices; C-MAC™ offered shorter intubation times, while GlideScope™, Storz DCI™, Truview PCD™, and Bullard™ had longer times.

Conclusions:

  • Network meta-analysis provides a coherent ranking of pediatric intubation device effectiveness.
  • Currently, no laryngoscope appears superior to the Macintosh laryngoscope for pediatric first-attempt intubation success and glottic visualization.
  • Device selection should consider specific outcomes like intubation time and failure rates.

Keywords:
direct laryngoscopesindirect laryngoscopesnetwork meta-analysispediatric

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