Videolaryngoscopes versus direct laryngoscopes in children: Ranking systematic review with network meta‐analyses of randomized clinical trials

Abstract

Background: Videolaryngoscopes improve tracheal intubation in adult patients, but we currently do not know whether they are similarly beneficial for children. We designed this ranking systematic review to compare individual video and direct laryngoscopes for efficacy and safety of orotracheal intubation in children. Methods:We searched PubMed and five other databases on January 27, 2021. We included randomized clinical trials with patients aged ≤18 years, comparing different laryngoscopes for the outcomes: failed first intubation attempt; failed intubation within two attempts; failed intubation; glottic view; time for intubation; complications. In addition, we assessed the quality of evidence according to GRADE recommendations. Results:We included 46 studies in the meta-analyses. Videolaryngoscopy reduced the risk of failed first intubation attempt (RR = 0.43; 95% CI: 0.31-0.61; p = .001) and failed intubation within two attempts (RR = 0.33; 95% CI: 0.33-0.33; p < .001) in children aged <1 year. Videolaryngoscopy also reduced the risk of major complications in both children aged <1 year (RR = 0.33; 95% CI: 0.12-0.96; p = .046) and children aged 0-18 years (RR = 0.40; 95% CI: 0.25-0.65; p = .002). We did not find significant difference between videolaryngoscopy and direct laryngoscopy for time to intubation in children aged <1 year (MD = −0.95 s; 95% CI: −5.45 to 3.57 s; p = .681), and children aged 0-18 years (MD = 1.65 s; 95% CI: −1.00 to 4.30 s; p = .222). Different videolaryngoscopes were associated with different performance metrics within this meta-analysis. The overall quality of the evidence ranged from low to very low. Conclusion:Videolaryngoscopes reduce the risk of failed first intubation attempts and major complications in children compared to direct laryngoscopes. However, not all videolaryngoscopes have the same performance metrics, and more data is needed to clarify which device may be better in different clinical scenarios. Additionally, care must be taken while interpreting our results and rankings due to the available evidence's low or very low quality.

Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time

“…A major change from the early cohort to the current cohort has been the dramatic increase in standard blade video laryngoscopy. There is a rapidly growing body of evidence that standard blade video laryngoscopy offers improved first attempt success and reduced rates of complications in infants and children with both normal and difficult airway anatomy, 22 , 24 , 25 which aligns with the most recent Cochrane review in adults. 26 Although video systems require a financial investment, these data can support cost effectiveness analysis in improving patient safety.…”

Comparison of the intubation time between McGRATHTM MAC size 1 and size 2 blades for infants: an observational study

“…However, more time for intubation was required for the use of video laryngoscopes because more time is required for the tube to pass through the glottis [6,7]. Reports comparing video laryngoscope models have not discovered a video laryngoscope model evidently advantageous for use in children [11][12][13]. Few studies have used McGRATH™ MAC on infants, especially since blade size 1, which is considered an appropriate size for infants, recently became available.…”

Comparison of the UEscope Video Laryngoscope with the Traditional Direct Laryngoscope in Neonates and Infants: A Randomized Clinical Trial

“…The decrease in TTI was in line with the findings of previous studies, which showed that, in children with difficult airways, the UEscope provided a better glottic view, higher first-attempt success rate, and shorter TTI [ 14 , 17 ]. On the contrary, a recent metanalysis including 46 RCTs of videoscope showed that video laryngoscopes reduced the risk of failed first intubation attempts but did not decrease TTI in children, although every video laryngoscope had a different performance metrics [ 18 ].…”