Direct Laryngoscopy Versus Video Laryngoscopy for Intubation in Critically Ill Patients: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials.

Autor:	McDougall GG; Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada., Flindall H; Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada., Forestell B; Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada., Lakhanpal D; Department of Biology, Faculty of Science, University of Toronto, Toronto, ON, Canada., Spence J; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.; Department of Anesthesia, McMaster University, Hamilton, ON, Canada., Cordovani D; Department of Anesthesia, McMaster University, Hamilton, ON, Canada., Sharif S; Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada.; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada., Rochwerg B; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2024 Nov 01; Vol. 52 (11), pp. 1674-1685. Date of Electronic Publication: 2024 Sep 18.
DOI:	10.1097/CCM.0000000000006402
Abstrakt:	Objectives: Given the uncertainty regarding the optimal approach to laryngoscopy for the intubation of critically ill adult patients, we conducted a systematic review and meta-analysis to compare video laryngoscopy (VL) vs. direct laryngoscopy (DL) for intubation in emergency department and ICU patients. Data Sources: We searched MEDLINE, PubMed, Embase, Cochrane Library, and unpublished sources, from inception to February 27, 2024. Study Selection: We included randomized controlled trials (RCTs) of critically ill adult patients randomized to VL compared with DL for endotracheal intubation. Data Extraction: Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model, assessed risk of bias using the modified Cochrane tool and certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach. We pre-registered the protocol on PROSPERO (CRD42023469945). Data Synthesis: We included 20 RCTs ( n = 4569 patients). Compared with DL, VL probably increases first pass success (FPS) (relative risk [RR], 1.13; 95% CI, 1.06-1.21; moderate certainty) and probably decreases esophageal intubations (RR, 0.47; 95% CI, 0.27-0.82; moderate certainty). VL may result in fewer aspiration events (RR, 0.74; 95% CI, 0.51-1.09; low certainty) and dental injuries (RR, 0.46; 95% CI, 0.19-1.11; low certainty) and may have no effect on mortality (RR, 0.97; 95% CI, 0.88-1.07; low certainty) compared with DL. Conclusions: In critically ill adult patients undergoing intubation, the use of VL, compared with DL, probably leads to higher rates of FPS and probably decreases esophageal intubations. VL may result in fewer dental injuries as well as aspiration events compared with DL with no effect on mortality. Competing Interests: Dr. Spence’s institution received funding from AOP Pharmaceuticals; she received funding from Trimedic Pharmaceuticals. Dr. Sharif disclosed they received the McMaster University Department of Medicine Early Career Award. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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