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Smith, Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: Difficulties with tracheal intubation commonly arise and impact patient safety. This systematic review evaluates whether videolaryngoscopes reduce intubation failure and complications compared with direct laryngoscopy in adults.
We included randomized controlled trials that compared adult patients undergoing laryngoscopy with videolaryngoscopy or Macintosh laryngoscopy. We did not primarily intend to compare individual videolaryngoscopes. Sixty-four studies participants were included.
Moderate quality evidence showed that videolaryngoscopy reduced failed intubations Odds Ratio OR 0. There was no evidence of reduction in hypoxia or mortality, but few studies reported these outcomes. Videolaryngoscopy increased easy laryngeal views OR 6. Failed intubations were reduced with experienced operators OR 0. We identified no difference in number of first attempts and incidence of sore throat.
Heterogeneity around time for intubation data prevented meta-analysis. We found evidence of differential performance between different videolaryngoscope designs. Lack of data prevented analysis of impact of obesity or clinical location on failed intubation rates. Videolaryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway. Currently, no evidence indicates that use of a videolaryngoscope reduces the number of intubation attempts or the incidence of hypoxia or respiratory complications, and no evidence indicates that use of a videolaryngoscope affects time required for intubation.
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