Videolaryngoscopy vs. direct Macintosh laryngoscopy in tracheal intubation in adults: a ranking systematic review and network meta-analysis

被引:38
|
作者
de Carvalho, C. C. [1 ]
Silva, D. M. [2 ]
Lemos, V. M. [2 ]
dos Santos, T. G. B. [2 ]
Agra, I. C. [3 ]
Pinto, G. M. [3 ]
Ramos, I. B. [3 ]
Costa, Y. S. C. [3 ]
Neto, J. M. Santos [2 ]
机构
[1] Univ Fed Campina Grande, Dept Surg, Campina Grande, Paraiba, Brazil
[2] Univ Fed Pernambuco, Support & Therapeut Diag Div, Hosp Clin, Anaesthesiol & Postanaesthet Care Unit, Recife, PE, Brazil
[3] Univ Fed Campina Grande, Ctr Ciencias Biol & Saude, Campina Grande, Paraiba, Brazil
关键词
airway management; laryngoscopy; network meta-analysis; systematic review; tracheal intubation; DIFFICULT AIRWAY; MANAGEMENT; GRADE; ANESTHETISTS; QUALITY; VIDEO;
D O I
10.1111/anae.15626
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Videolaryngoscopes are thought to improve glottic view and facilitate tracheal intubation compared with the Macintosh direct laryngoscope. However, we currently do not know which one would be the best choice in most patients undergoing anaesthesia. We designed this systematic review with network meta-analyses to rank the different videolaryngoscopes and the Macintosh direct laryngoscope. We conducted searches in PubMed and a further five databases on 11 January 2021. We included randomised clinical trials with patients aged >= 16 years, comparing different videolaryngoscopes, or videolaryngoscopes with the Macintosh direct laryngoscope for the outcomes: failed intubation; failed first intubation attempt; failed intubation within two attempts; difficult intubation; percentage of glottic opening seen; difficult laryngoscopy; and time needed for intubation. We assessed the quality of evidence according to GRADE recommendations and included 179 studies in the meta-analyses. The C-MAC and C-MAC D-Blade were top ranked for avoiding failed intubation, but we did not find statistically significant differences between any two distinct videolaryngoscopes for this outcome. Further, the C-MAC D-Blade performed significantly better than the C-MAC Macintosh blade for difficult laryngoscopy. We found statistically significant differences between the laryngoscopes for time to intubation, but these differences were not considered clinically relevant. The evidence was judged as of low or very low quality overall. In conclusion, different videolaryngoscopes have differential intubation performance and some may be currently preferred among the available devices. Furthermore, videolaryngoscopes and the Macintosh direct laryngoscope may be considered clinically equivalent for the time taken for tracheal intubation. However, despite the rankings from our analyses, the current available evidence is not sufficient to ensure significant superiority of one device or a small set of them over the others for our intubation-related outcomes.
引用
收藏
页码:326 / 338
页数:13
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