Orotracheal intubation success in adults is greater with videolaryngoscopy than direct laryngoscopy
Orotracheal intubation success in adults is greater with videolaryngoscopy than direct laryngoscopy
SOURCE
Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF.
Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation.
Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD011136.
DOI: 10.1002/14651858.CD011136.pub3.
CONTEXT
Tracheal intubation is a common procedure in operating theatres, emergency departments,
outpatient departments and critical care units. In around 10% of cases, intubation is difficult and
associated with a risk of complications: hypoxemia, inhalation pneumonitis, rhythm disorders,
cardiac arrest and death. The use of a videolaryngoscope (VL) could reduce this risk when used in
patients with difficult intubation criteria, or when the difficulty was not predicted. There are 3
different types of VL: Macintosh-style VL, hyperangulated VL and tunnelled VL.
CLINICAL QUESTIONS
Is the use of different types of VL in adults requiring orotracheal intubation associated with better
results compared with direct laryngoscopy? What are the benefits of these devices in selected
population groups, users, and settings?
BOTTOM LINE
Compared with direct laryngoscopy, the 3 types of VL probably significantly reduce the intubation
failure rate (moderate certainty evidence), probably improve glottic vision (moderate certainty
evidence) and the intubation success rate on the first attempt (low certainty evidence for
Macintosh-style LV and hyperangulated LV, and very-low certainty evidence for tunnelled LV).
Macintosh-style LV and tunnelled LV probably reduce the rate of hypoxemia (moderate certainty
evidence), and hyperangulated LV is probably associated with a lower rate of esophageal intubation
(moderate certainty evidence). Combining all 3 types of VL, their use is associated with a reduced
rate of intubation failure in patients at risk of difficult intubation and in obese patients. The use of
VLs may also be beneficial outside the operating theatre. Results do not appear to be influenced by
operator experience.
CAVEATS
This review did not compare the 3 types of VL. None appears to be associated with a better outcome
than the others. It is important to point out that only 9% of the included studies were conducted
outside the operating room, which precludes generalization to out-of-hospital settings, emergency
departments and critical care units.
AUTHORS
Mathieu Oberlin
mathieu.oberlin@outlook.fr
Centre Hospitalier de Selestat, F-67600 Strasbourg, France
Patricia Jabre
patricia.jabre@aphp.fr
SAMU de Paris, F-75015 Paris, France
Chady El Tawil
Chady.eltawil.med@ssss.gouv.qc.ca
Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières (Québec), Canada
Montreal Children’s Hospital, Montreal (Québec), Canada
