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

Abstract

This research aimed to produce a coherent ranking of the effectiveness of intubation devices in pediatric patients using network meta-analysis (NMA). We searched the electric databases for prospective randomized studies that compared different tracheal intubation devices in pediatric patients. The primary outcome was intubation failure at the first attempt. Secondary outcomes were glottic visualization and intubation time. The statistical analysis performed used DerSimonian and Laird random-effects models. Frequentist network meta-analysis was conducted, and network plots and network league tables were produced. Subgroup analysis was performed after excluding rigid-fiberscope-type indirect laryngoscopes. Thirty-four trials comparing 13 devices were included. Most laryngoscopes had the same intubation failure rate as the Macintosh reference device. Only the Truview PCD™ had a significantly higher intubation failure rate than the Macintosh (odds ratio 4.78, 95% confidence interval 1.11–20.6) The highest-ranking laryngoscope was the Airtaq™ (P score, 0.90), and the AirwayScope™, McGrath™, and Truview EVO2™ ranked higher than the Macintosh. The Bullard™ had the lowest ranking (P score, 0.08). All laryngoscopes had the same level of glottic visualization as the Macintosh and only the C-MAC™ had a significantly shorter intubation time. Intubation time was significantly longer when using the GlideScope™, Storz DCI™, Truview PCD™, or Bullard™ compared with the Macintosh. P score and ranking of devices in the subgroup analyses were similar to those in the main analysis. We applied NMA to create a consistent ranking of the effectiveness of intubation devices in pediatric patients. The findings of NMA suggest that there is presently no laryngoscope superior to the Macintosh laryngoscope in terms of tracheal intubation failure rate and glottic visualization in pediatric patients.

Ultrasonic Measurement of the Narrowest Transverse Diameter of Subglottic Airway in Children Undergoing Elective Tracheal Intubation under General Anesthesia

“…However, there are huge individual differences in the growth and development of children. Since the organ catheter model can't be accurately selected, repeated intubation attempts are needed to determine the optimal model of endotracheal tube (ETT) [4][5][6]. During this period, it is easy to induce hypoxemia, air leakage, re ux aspiration, and even laryngeal tissue damage; in severe cases, it will also lead to cardiac arrest.…”

Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis

“…Additionally, White et al reported that Airtraq significantly prolonged intubation time compared to direct laryngoscopes [10]. Furthermore, a previous network meta-analysis comparing indirect and direct laryngoscopes in pediatric patients reported that there were no significant differences between the two laryngoscopes in terms of success rate, intubation time, and glottic visualization in tracheal intubation [11,12]. However, this report did not focus on patients with difficult airways, so the usefulness of the indirect laryngoscope in pediatric patients with difficult intubation is not known.…”