Summary Videolaryngoscopes are thought to improve glottic view and facilitate tracheal intubation compared with the Macintosh direct laryngoscope. However, we currently do not know which one would be the best choice in most patients undergoing anaesthesia. We designed this systematic review with network meta‐analyses to rank the different videolaryngoscopes and the Macintosh direct laryngoscope. We conducted searches in PubMed and a further five databases on 11 January 2021. We included randomised clinical trials with patients aged ≥16 years, comparing different videolaryngoscopes, or videolaryngoscopes with the Macintosh direct laryngoscope for the outcomes: failed intubation; failed first intubation attempt; failed intubation within two attempts; difficult intubation; percentage of glottic opening seen; difficult laryngoscopy; and time needed for intubation. We assessed the quality of evidence according to GRADE recommendations and included 179 studies in the meta‐analyses. The C‐MAC and C‐MAC D‐Blade were top ranked for avoiding failed intubation, but we did not find statistically significant differences between any two distinct videolaryngoscopes for this outcome. Further, the C‐MAC D‐Blade performed significantly better than the C‐MAC Macintosh blade for difficult laryngoscopy. We found statistically significant differences between the laryngoscopes for time to intubation, but these differences were not considered clinically relevant. The evidence was judged as of low or very low quality overall. In conclusion, different videolaryngoscopes have differential intubation performance and some may be currently preferred among the available devices. Furthermore, videolaryngoscopes and the Macintosh direct laryngoscope may be considered clinically equivalent for the time taken for tracheal intubation. However, despite the rankings from our analyses, the current available evidence is not sufficient to ensure significant superiority of one device or a small set of them over the others for our intubation‐related outcomes.
BackgroundVideolaryngoscopes (VLs) are regarded to improve glottic visualization as compared to Macintosh laryngoscope (ML). However, we currently do not know which one would be the best choice. We then designed this systematic review and network meta-analysis to rank the different VLs as compared to ML.MethodsWe will conduct a search in PubMed, LILACS, Scielo, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 6) on 11/01/2021. We will include randomized clinical trials fully reported with patients aged ≥ 16 years, comparing VLs with ML for failed intubation with the device, failed first intubation attempts, number of intubation attempts, time for intubation, difficulty of intubation, and improved visualization of the larynx. Pooled effects will be estimated by both fixed and random-effects models and presented according to qualitative and quantitative heterogeneity assessment. Sensitivity analyses will be performed as well as a priori subgroup, meta-regression and multiple meta-regression analyses. Additionally, network meta-analyses will be applied to rank the different VLs as compared to ML. We will also assess the risk of selective publication by funnel plot asymmetry.DiscussionThis systematic review and network meta-analysis aim at helping health services and clinicians involved in airway manipulation choose the best VLs for orotracheal intubation.Systematic review registrationThe current protocol was submitted to PROSPERO on 07/01/2021.
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