Videolaryngoscopy in children and neonates reduced intubation trauma & improved indirect glottic view, although demonstrated no other benefits.

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• Xiaoxue Hu, Yi Jin, Jiansong Li, Jiechen Xin, and Zeyong Yang.
• Department of Anesthesiology, Guanghua Integrative Medicine Hospital, Shanghai university of traditional Chinese Medicine, Shanghai 200052, China.
• J Clin Anesth. 2020 Nov 1; 66: 109968.

ObjectiveAnatomical and physiological differences in paediatric and adult airways make intubation of paediatric patients a challenge. This study aimed to compare the efficacy and safety of video laryngoscopy (VL) to direct laryngoscopy (DL) on intubation outcomes in paediatric patients.DesignSystematic review and meta-analysis.SettingOperating room.PatientsPaediatric patients who needed tracheal intubation.InterventionVideo laryngoscopy or direct laryngoscopy.MeasurementsElectronic searches in PubMed, Embase, and the Cochrane Library were performed to identify relevant randomized controlled trials published through January 2020. Outcomes included time to intubate, intubation failure at first attempt, Cormack-Lehane laryngeal view grade, intubation difficulty scale (IDS), percentage of glottic opening score (POGO), optimal external laryngeal manipulation (OLEM), and complications. Relative risks and weighted mean difference (WMD), with 95% CI, were employed to calculate summary results using a random-effects model.Main ResultsOverall, 27 trials including 2461 paediatric patients were analysed. Children with video laryngoscopy intubation required longer time to intubate than direct laryngoscopy intubation (WMD 3.41, 95% CI: 1.29-5.53, P = 0.002), whereas infants receiving video laryngoscopy and direct laryngoscopy intubation experienced similar time to intubate (WMD 1.72, 95% CI: -1.09-4.54, P = 0.230). No significant differences were observed on intubation failure at first attempt between video laryngoscopy and direct laryngoscopy intubations in children and infants, respectively. Video laryngoscopy improved the POGO and intubation trauma but not Cormack-Lehane laryngeal view grade, IDS, external laryngeal manipulation, hoarseness, or oxygen desaturation.ConclusionsCompared with direct laryngoscopy intubation, there were no benefits for paediatric patients with video laryngoscopy on time to intubate and failure at first attempt, but there were benefits with regard to POGO and intubation trauma.Copyright © 2020 Elsevier Inc. All rights reserved.

This article appears in the collection: Are video laryngoscopes superior to standard laryngoscopy?.

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