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01-05-2014 | Original

Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis

Authors: Audrey De Jong, Nicolas Molinari, Matthieu Conseil, Yannael Coisel, Yvan Pouzeratte, Fouad Belafia, Boris Jung, Gérald Chanques, Samir Jaber

Published in: Intensive Care Medicine | Issue 5/2014

Abstract

Purpose

Single studies of video laryngoscopy (VL) use for airway management in intensive care unit (ICU) patients have produced controversial findings. The aim of this study was to critically review the literature to investigate whether VL reduces difficult orotracheal intubation (OTI) rate, first-attempt success, and complications related to intubation in ICU patients, compared to standard therapy, defined as direct laryngoscopy (DL).

Methods

We performed a systematic review and meta-analysis of randomized controlled trials, as well as prospective and retrospective observational studies, by searching PubMed, EMBASE, and bibliographies of articles retrieved. We screened for relevant studies that enrolled adults in whom the trachea was intubated in the ICU and compared VL to DL. We included studies reporting at least one clinical outcome of interest to perform a meta-analysis. We generated pooled odd ratios (OR) across studies. The primary outcome measure was difficult OTI. The secondary outcomes were first-attempt success, Cormack 3/4 grades, and complications related to intubation (severe hypoxemia, severe cardiovascular collapse, airway injury, esophageal intubation).

Results

Nine trials with a total of 2,133 participants (1,067 in DL and 1,066 in VL) were included in the current analysis. Compared to DL, VL reduced the risk of difficult OTI [OR 0.29 (95 % confidence interval (CI) 0.20–0.44, p < 0.001)], Cormack 3/4 grades [OR 0.26 (95 % CI 0.17–0.41, p < 0.001)], and esophageal intubation [0.14 (95 % CI 0.02–0.81, p = 0.03)] and increased the first-attempt success [OR 2.07 (95 % CI 1.35–3.16, p < 0.001)]. No statistically significant difference was found for severe hypoxemia, severe cardiovascular collapse or airway injury.

Conclusions

These results suggest that VL could be useful in airway management of ICU patients.

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Title: Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis
Authors: Audrey De Jong
Nicolas Molinari
Matthieu Conseil
Yannael Coisel
Yvan Pouzeratte
Fouad Belafia
Boris Jung
Gérald Chanques
Samir Jaber
Publication date: 01-05-2014
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3236-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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