Videolaryngoscopy vs. Macintosh laryngoscopy for double‐lumen tube intubation in thoracic surgery: a systematic review and meta‐analysis

Abstract

Double-lumen intubation is more difficult than single-lumen tracheal intubation. Videolaryngoscopes have many advantages in airway management. However, the advantages of videolaryngoscopy for intubation with a double-lumen tube remain controversial compared with traditional Macintosh laryngoscopy. In this study, we searched MEDLINE, Embase, Cochrane Library and the Web of Science for randomised controlled trials comparing videolaryngoscopy with Macintosh laryngoscopy for double-lumen tube intubation. We found that videolaryngoscopy provided a higher success rate at first attempt for double-lumen tube intubation, with an odds ratio (95%CI) of 2.77 (1.92-4.00) (12 studies, 1215 patients, moderate-quality evidence, p < 0.00001), as well as a lower incidence of oral, mucosal or dental injuries during double-lumen tube intubation, odds ratio (95%CI) 0.36 (0.15-0.85) (11 studies, 1145 patients, low-quality evidence, p = 0.02), and for postoperative sore throat, odds ratio (95%CI) 0.54 (0.36-0.81) (7 studies, 561 patients, moderate-quality evidence, p = 0.003), compared with Macintosh laryngoscopy. There were no significant differences in intubation time, with a standardised mean difference (95%CI) of -0.10 (-0.62 to 0.42) (14 studies, 1310 patients, very low-quality evidence, p = 0.71); and the incidence of postoperative voice change, odds ratio (95%CI) 0.53 (0.21-1.31) (7 studies, 535 patients, low-quality evidence, p = 0.17). Videolaryngoscopy led to a higher incidence of malpositioned double-lumen tube, with an odds ratio (95%CI) of 2.23 (1.10-4.52) (six studies, 487 patients, moderate-quality evidence, p = 0.03).

Prospective, randomised, controlled study comparing Videolaryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Tube Intubation in thoracic surgery

“…In (8). Considering only the four studies using GlideScope® videolaryngoscopy of that meta-analysis, our results are consistent with three of these four studies (6,7,16,17).…”

Videolaryngoscopy versus direct laryngoscopy for double-lumen endotracheal tube intubation in thoracic surgery - a randomised controlled clinical trial

“…Rotation manoeuvre more often results in the incorrect position of the DLT. Liu et al concluded that the use of videolaryngoscopes, especially with a hyper-angulated blade for DLT intubation, complicates the already complicated DLT intubation technique through rotation manoeuvres [10]. Our data support the thesis that these sequential rotation manoeuvres are probably the reason why videolaryngoscopy increases the incidence of mispositioning of DLT.…”

“…Contrary, a recent meta-analysis in 2018 by Liu et al, showed no difference in intubation time. The metaanalysis included studies with various videolaryngoscopes like Airtraq, McGrath Series 5, McGrath MAC -not all of these provide hyperacute angled devices [10]. Considering only the four studies using GlideScope® videolaryngoscopy included in the meta-analysis, our results are consistent with three of these four studies [8,9,15,16].…”

“…In DLT intubation, the literature shows conflicting results of the benefits of videolaryngoscopy compared to direct laryngoscopy, especially intubation time as well as iatrogenic injuries [8,9]. Moreover, meta-analysis data with moderate to low quality evidence exist, showing a higher success rate at first attempt, a higher incidence of malpositioned double-lumen tube and a lower incidence of oral, mucosal or dental injuries with videolaryngoscopy for DLT intubation [10].…”

Different classes of videoscopes and direct laryngoscopes for double-lumen tube intubation in thoracic surgery: A systematic review and network meta-analysis

“…In the 23 RCTs, we identified a total of 11 different intubating devices, that were further classified and lumped into four groups based on their shapes and features: videolaryngoscope with guiding channel (channeled videolaryngoscope; CV), non-channeled videolaryngoscope (standard videolaryngoscope; SV), videostylet (stylet V), and Macintosh direct laryngoscope (Mc) [ 21 – 23 ]. We lumped Airtraq, AW, and KVL in the CV group; CEL-100, Glidescope, McGrath, and C-MAC in the SV group; and OptiScope, Shikani, and Trachway in the stylet V group.…”