Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis

Abstract

The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.

A Paradigm Shift of Airway Management: The Role of Video-Assisted Intubating Stylet Technique

“…The clinical role of VL on tracheal intubation with double-lumen endobronchial tube (DLEB tube) for thoracic surgeries has been reviewed [172,173]. For tracheal intubation with double-lumen endobronchial tube, VL was found either to be superior or equivalent to DL [174][175][176][177][178][179].…”

A Randomized Study of Rigid Video Stylet versus Macintosh Laryngoscope for Double-Lumen Endobronchial Tube Intubation Assistance in Thoracoscopic Pulmonary Surgery

“…Video laryngoscope-assisted DLT intubation has been proved to be superior over traditional direct laryngoscope in terms of the intubation time and glottic view in multiple studies [ 14 ]. Not only the assisting tools that have been developed but DLT itself could be equipped with a video system, and this consequently reduces the need for fiberoptic bronchoscopy [ 15 ], with which the intubation time could be shortened and the success rate could be improved for senior anesthesiologists in a manikin model [ 16 ].…”

Comparison of the C-MAC D-blade video laryngoscope and the McCoy laryngoscope for double-lumen endotracheal tube intubation: A prospective randomized controlled study

“…[ 8 – 10 , 18 ] However, some researchers reported that video laryngoscopes require a longer or shorter intubation time than the Macintosh laryngoscope. [ 12 , 19 , 20 ] This heterogeneity of previous findings might be explained by different definitions of the intubation time, type of video laryngoscope, and operators’ experience. [ 18 , 19 ] A previous meta-analysis indicated that novice operators may require more time to perform DLT intubation with video laryngoscopes than with the Macintosh laryngoscope.…”

“…[ 12 , 19 , 20 ] This heterogeneity of previous findings might be explained by different definitions of the intubation time, type of video laryngoscope, and operators’ experience. [ 18 , 19 ] A previous meta-analysis indicated that novice operators may require more time to perform DLT intubation with video laryngoscopes than with the Macintosh laryngoscope. [ 18 ] In this study, a single experienced anesthesiologist performed intubation, and the intubation time was defined as passage of the intubation device through the lips to connect the DLT and a circuit of anesthesia workstation to measure the time taken only for the intubation technique.…”