Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-analysis

Background

Endotracheal intubation (EI) in intensive care unit (ICU) patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in expertise of operators. We aimed to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI.

Methods

We searched for relevant studies in PubMed, Embase, and the Cochrane database from inception up to Jan 30, 2017. Randomized controlled trials (RCTs) were included if they reported data on any of the predefined outcomes in ICU patients requiring EI and managed with VL or DL. Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI).

Results

Five RCTs with 1,301 patients were included. Despite better glottic visualization with VL (RR = 1.24; 95% CI, 1.07 to 1.43; P = 0.003), use of VL did not result in a significant increase in first-attempt success rate (RR = 1.08; 95% CI, 0.92 to 1.26; P = 0.35) when compared with DL. In addition, time to intubation (MD = 4.12 seconds; 95% CI, -15.86 to 24.09; P = 0.69), difficult intubation (RR = 0.72, 95% CI, 0.30 to 1.70; P = 0.45), mortality (RR = 1.02, 95% CI, 0.84 to 1.25; P = 0.83), and most other complications were similar between VL and DL groups.

Conclusions

VL technique did not increase first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.

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