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.

中文翻译：

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成人气管插管中的视频喉镜与直接 Macintosh 喉镜：系统评价和网络荟萃分析

与 Macintosh 直接喉镜相比，视频喉镜被认为可以改善声门视野并促进气管插管。然而，我们目前不知道对于大多数接受麻醉的患者来说，哪一种是最佳选择。我们通过网络荟萃分析设计了本系统评价，以对不同的视频喉镜和 Macintosh 直接喉镜进行排名。我们于 2021 年 1 月 11 日在 PubMed 和另外五个数据库中进行了搜索。我们纳入了年龄≥16 岁患者的随机临床试验，比较了不同的视频喉镜或视频喉镜与 Macintosh 直接喉镜的结果：插管失败；第一次插管尝试失败；两次尝试插管失败；插管困难；声门开口的百分比；喉镜检查困难；以及插管所需的时间。我们根据 GRADE 推荐评估了证据的质量，并在荟萃分析中纳入了 179 项研究。C-MAC 和 C-MAC D-Blade 在避免插管失败方面名列前茅，但我们没有发现任何两种不同的视频喉镜在这一结果方面存在统计学显着差异。此外，对于困难的喉镜检查，C-MAC D-Blade 的性能明显优于 C-MAC Macintosh 刀片。我们发现喉镜在插管时间方面存在统计学上的显着差异，但这些差异不被认为具有临床相关性。证据总体上被判定为低质量或非常低质量。总之，不同的视频喉镜具有不同的插管性能，目前在可用设备中可能首选一些。此外，可视喉镜和 Macintosh 直接喉镜在气管插管时间上被认为是临床等效的。然而，尽管我们的分析进行了排名，但目前可用的证据不足以确保一个设备或一小部分设备在我们的插管相关结果方面优于其他设备。