Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials

Summary Background We reviewed the updated literature and performed a meta‐analysis based on randomized controlled trials in children to compare the clinical efficacy between video laryngoscopes (VLs) and direct laryngoscopes (DLs). Methods We searched articles published in English matching the key...

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Bibliographic Details
Published in:Pediatric anesthesia 2014-10, Vol.24 (10), p.1056-1065
Main Authors: Sun, Yu, Lu, Yi, Huang, Yan, Jiang, Hong
Format: Article
Language:English
Subjects:
Adolescent
Child
Child, Preschool
Female
Glottis - anatomy & histology
Humans
Infant
Infant, Newborn
intubation
laryngoscope
Laryngoscopes
Laryngoscopy - methods
Male
meta-analysis
pediatric
quality effects
Randomized Controlled Trials as Topic
Treatment Failure
Treatment Outcome
video
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Summary:Summary Background We reviewed the updated literature and performed a meta‐analysis based on randomized controlled trials in children to compare the clinical efficacy between video laryngoscopes (VLs) and direct laryngoscopes (DLs). Methods We searched articles published in English matching the key words ‘video laryngoscope (including Airtraq, GlideScope, Storz, TruView, AWS, Bullard, McGrath)’ AND ‘direct laryngoscope’ AND ‘children (including pediatric, infant, neonate)’ in PubMed, Ovid, Google Scholar, and the Cochrane Library databases. Only prospective randomized controlled trials (RCTs), which compared the use of VLs and DLs in children, were included. The relative risk (RR), weighted mean difference (WMD), and their corresponding 95% confidence interval (95% CI) were calculated using the quality effects model of the metaxl 1.3 software for outcome data. Results Fourteen studies were included in this meta‐analysis. Although VLs improved the glottis visualization in most children either with normal airways or with potentially difficult intubations, the time to intubation (TTI) was prolonged in comparison to DLs (WMD: 4.9 s; 95% CI: 2.6–7.1). Subgroup analysis showed the GlideScope (WMD: 5.2 s; 95% CI: 2.0–8.5), TruView (WMD: 5.1 s; 95% CI: 0.7–9.5), Storz (WMD: 6.4 s; 95% CI: 4.8–8.1), and Bullard (WMD: 37.5 s; 95% CI: 21.0–54.0) rather than Airtraq (WMD: 0.6 s; 95% CI: −7.7–8.9) prolonged TTI. Although the success rate of the first attempt (RR: 0.96; 95% CI: 0.92–1.00) and associated complications (RR: 1.11; 95% CI: 0.39–3.16) were similar in both groups, VLs were associated with a higher incidence of failure (RR: 6.70; 95% CI: 1.53–29.39). Conclusion This meta‐analysis demonstrates that although VLs improved glottis visualization in pediatric patients, this was at the expense of prolonged TTI and increased failures. However, further studies are needed to clarify the efficacy and safety of VLs in hands of nonexperts and in children with airway problems.
ISSN:1155-5645
1460-9592
DOI:10.1111/pan.12458