Background

Tracheal intubation is a commonly performed procedure that can be associated with complications and result in patient harm. Videolaryngoscopy (VL) may decrease this risk as compared with Macintosh direct laryngoscopy (DL). This review evaluates the risk and benefit profile of VL compared with DL in adults.

Methods

We searched MEDLINE, Embase, CENTRAL, and Web of Science on February 27, 2021. We included RCTs comparing VL with DL in patients undergoing tracheal intubation in any setting. We separately compared outcomes according to VL design: Macintosh-style, hyperangulated, and channelled.

Results

A total of 222 RCTs (with 26 149 participants) were included. Most studies had unclear risk of bias in at least one domain, and all were at high risk of performance and detection bias. We found that videolaryngoscopes of any design likely reduce rates of failed intubation (Macintosh-style: risk ratio [RR]=0.41; 95% confidence interval [CI], 0.26–0.65; hyperangulated: RR=0.51; 95% CI, 0.34–0.76; channelled: RR=0.43, 95% CI, 0.30–0.61; moderate-certainty evidence) with increased rates of successful intubation on first attempt and better glottic views across patient groups and settings. Hyperangulated designs are likely favourable in terms of reducing the rate of oesophageal intubation, and result in improved rates of successful intubation in individuals presenting with difficult airway features (P=0.03). We also present other patient-oriented outcomes.

Conclusions

In this systematic review and meta-analysis of trials of adults undergoing tracheal intubation, VL was associated with fewer failed attempts and complications such as hypoxaemia, whereas glottic views were improved.

Systematic review registration

This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2022, Issue 4, DOI: 10.1002/14651858.CD011136.pub3 (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.

中文翻译：

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成人气管插管的视频喉镜与直接喉镜检查：Cochrane 系统评价和荟萃分析更新

背景

气管插管是一种常见的手术，可能会导致并发症并导致患者受伤。与 Macintosh 直接喉镜 (DL) 相比，视频喉镜 (VL) 可能会降低这种风险。本综述评估了成人 VL 与 DL 的风险和益处。

方法

我们于 2021 年 2 月 27 日检索了 MEDLINE、Embase、CENTRAL 和 Web of Science。我们纳入了比较在任何情况下接受气管插管的患者的 VL 与 DL 的随机对照试验。我们根据 VL 设计分别比较了结果：Macintosh 风格、超角度设计和通道设计。

结果

总共纳入 222 项随机对照试验（26 149 名受试者）。大多数研究至少在一个领域存在不清楚的偏倚风险，并且所有研究都存在很高的性能和检测偏倚风险。我们发现任何设计的视频喉镜都可能降低插管失败率（Macintosh 式：风险比 [RR]=0.41；95% 置信区间 [CI]，0.26–0.65；超角度：RR=0.51；95% CI，0.34– 0.76；引导：RR=0.43，95% CI，0.30-0.61；中等质量证据），首次尝试插管成功率增加，并且在不同患者组和环境中获得更好的声门视图。超角度设计可能有利于降低食管插管率，并提高具有困难气道特征的个体插管的成功率（P = 0.03）。我们还提出了其他以患者为中心的结果。

结论

在这项针对成人气管插管试验的系统回顾和荟萃分析中，VL 与较少的失败尝试和低氧血症等并发症相关，而声门视图得到改善。

系统审核注册

本文基于 Cochrane 系统评价数据库 (CDSR) 2022 年第 4 期发表的 Cochrane 综述，DOI：10.1002/14651858.CD011136.pub3（有关信息，请参阅 www.cochranelibrary.com）。随着新证据的出现和对反馈的回应，Cochrane 综述会定期更新，并且应咨询 CDSR 以获取最新版本的综述。