Videolaryngoscopes versus direct laryngoscopes in children: Ranking systematic review with network meta-analyses of randomized clinical trials

被引:22
作者
de Carvalho, Clistenes C. [1 ]
Regueira, Stephanie L. P. A. [2 ]
Souza, Ana Beatriz S. [3 ]
Medeiros, Lucas M. L. F. [3 ]
Manoel, Marielle B. S. [3 ]
da Silva, Danielle M. [3 ]
Santos Neto, Jayme M. [4 ]
Peyton, James [4 ,5 ,6 ]
机构
[1] Inst Med Integral Prof Fernando Figueira, Dept Postgrad, Recife, PE, Brazil
[2] Univ Fed Campina Grande, Dept Surg, Campina Grande, Paraiba, Brazil
[3] Univ Fed Campina Grande, Ctr Ciencias Biol & Saude, Campina Grande, Paraiba, Brazil
[4] Univ Fed Pernambuco, Hosp Clin, Anesthesiol & Postanesthet Care Unit, Recife, PE, Brazil
[5] Boston Childrens Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA
[6] Harvard Med Sch, Boston, MA 02115 USA
关键词
airway management; laryngoscopy; network meta-analysis; systematic review; tracheal intubation; TRACHEAL INTUBATION; VIDEO LARYNGOSCOPE; GRADE; DIFFICULT; QUALITY;
D O I
10.1111/pan.14521
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background Videolaryngoscopes improve tracheal intubation in adult patients, but we currently do not know whether they are similarly beneficial for children. We designed this ranking systematic review to compare individual video and direct laryngoscopes for efficacy and safety of orotracheal intubation in children. Methods We searched PubMed and five other databases on January 27, 2021. We included randomized clinical trials with patients aged <= 18 years, comparing different laryngoscopes for the outcomes: failed first intubation attempt; failed intubation within two attempts; failed intubation; glottic view; time for intubation; complications. In addition, we assessed the quality of evidence according to GRADE recommendations. Results We included 46 studies in the meta-analyses. Videolaryngoscopy reduced the risk of failed first intubation attempt (RR = 0.43; 95% CI: 0.31-0.61; p = .001) and failed intubation within two attempts (RR = 0.33; 95% CI: 0.33-0.33; p < .001) in children aged <1 year. Videolaryngoscopy also reduced the risk of major complications in both children aged <1 year (RR = 0.33; 95% CI: 0.12-0.96; p = .046) and children aged 0-18 years (RR = 0.40; 95% CI: 0.25-0.65; p = .002). We did not find significant difference between videolaryngoscopy and direct laryngoscopy for time to intubation in children aged <1 year (MD = -0.95 s; 95% CI: -5.45 to 3.57 s; p = .681), and children aged 0-18 years (MD = 1.65 s; 95% CI: -1.00 to 4.30 s; p = .222). Different videolaryngoscopes were associated with different performance metrics within this meta-analysis. The overall quality of the evidence ranged from low to very low. Conclusion Videolaryngoscopes reduce the risk of failed first intubation attempts and major complications in children compared to direct laryngoscopes. However, not all videolaryngoscopes have the same performance metrics, and more data is needed to clarify which device may be better in different clinical scenarios. Additionally, care must be taken while interpreting our results and rankings due to the available evidence's low or very low quality.
引用
收藏
页码:1000 / 1014
页数:15
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