Background

Awake tracheal intubation is commonly performed with flexible bronchoscopes, but the emerging role of alternative airway devices, such as videolaryngoscopes, direct laryngoscopes, and optical stylets, has been recognised.

Methods

CENTRAL, CINAHL, EMBASE, MEDLINE, and Web of Science were searched for RCTs that compared flexible bronchoscopes, direct laryngoscopes, optical stylets and channelled or unchannelled videolaryngoscopes in adult patients having awake tracheal intubation were included. The co-primary outcomes were first-pass success rate and time to tracheal intubation. Continuous outcomes were extracted as mean and standard deviation, and dichotomous outcomes were converted to overall numbers of incidence. Frequentist network meta-analysis was conducted, and network plots and network league tables were produced.

Results

Twelve RCTs were included, none of which evaluated direct laryngoscopes. The first-pass success rate was not different between flexible bronchoscopes, optical stylets, and channelled and unchannelled videolaryngoscopes, with the quality of evidence rated as moderate in view of imprecision. Optical stylets, followed by unchannelled videolaryngoscopes and then felxible bronchoscopes resulted in the shortest time to tracheal intubation, with the quality of evidence rated as high. No differences were shown between the airway devices with respect to the incidence of oesophageal intubation, change of airway technique, oxygen desaturation, airway bleeding, or the rate of hoarseness and sore throat.

Conclusions

Flexible bronchoscopes, optical stylets, and channelled and unchannelled videolaryngoscopes were clinically comparable airway devices in the setting of awake trachela intubation and the time to tracheal intubation was shortest with optical stylets and longest with flexible bronchoscopes.

中文翻译：

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成人清醒气管插管的气道装置：系统评价和网络荟萃分析

背景

清醒气管插管通常使用柔性支气管镜进行，但替代气道设备（例如视频喉镜、直接喉镜和光学管心针）的新兴作用已得到认可。

方法

在 CENTRAL、CINAHL、EMBASE、MEDLINE 和 Web of Science 中搜索了 RCT，这些 RCT 在清醒气管插管的成年患者中比较了柔性支气管镜、直接喉镜、光学管心针和通道或非通道视频喉镜。共同主要结果是首次通过成功率和气管插管时间。连续结果被提取为平均值和标准差，二分结果被转换为总发生率。进行了频率论网络元分析，并制作了网络图和网络排行榜。

结果

包括 12 项 RCT，其中没有一项评估直接喉镜。软式支气管镜、光学管心针、通道式和非通道式视频喉镜的首次通过成功率没有差异，证据质量因不精确而被评为中等。光学管心针，其次是未引导的视频喉镜，然后是柔性支气管镜，导致气管插管的时间最短，证据质量被评为高。在食管插管的发生率、气道技术的改变、氧饱和度下降、气道出血或声音嘶哑和喉咙痛的发生率方面，气道装置之间没有差异。

结论

在清醒气管插管的情况下，柔性支气管镜、光学管心针以及通道和非通道视频喉镜是临床上可比较的气道装置，光学管心针的气管插管时间最短，而柔性支气管镜的气管插管时间最长。