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The following is a summary of “Direct laryngoscopy versus video laryngoscopy for intubation in critically ill patients: A systematic review, meta-analysis, and trial sequential analysis of randomized trials,” published in the September 2024 issue of Critical Care by McDougall et al.

Researchers conducted a retrospective study to compare video laryngoscopy (VL) vs direct laryngoscopy (DL) for intubation in patients with critical illness in emergency departments and ICU.

They searched MEDLINE, PubMed, Embase, Cochrane Library, and unpublished sources from inception to February 27, 2024. They included randomized controlled trials (RCTs) of critically ill adult patients randomized to VL compared with DL for endotracheal intubation, screened abstracts full texts, and extracted data in duplicate. Data was pooled by a random-effects model, the risk of bias was evaluated using the modified Cochrane tool, and the certainty of evidence was evaluated using the Grading Recommendations Assessment, Development, and Evaluation approach. They pre-registered the protocol on PROSPERO.

The results showed that 20 RCTs involving 4,569 patients were compared to DL, VL likely increases first-pass success (FPS) with a relative risk (RR) of 1.13 (95% CI, 1.06–1.21; moderate certainty) and decreases esophageal intubations (RR, 0.47; 95% CI, 0.27–0.82; moderate certainty) while, VL may lead to fewer aspiration events (RR, 0.74; 95% CI, 0.51–1.09; low certainty) and dental injuries (RR, 0.46; 95% CI, 0.19–1.11; low certainty), and it may have no significant effect on mortality (RR, 0.97; 95% CI, 0.88–1.07; low certainty) when compared with DL.

They concluded that for critically ill adult patients undergoing intubation, the use of VL, compared with DL, probably leads to higher rates of FPS and probably decreases esophageal intubations; VL may result in fewer dental injuries and aspiration events compared with DL, which does not affect mortality.

Source: journals.lww.com/ccmjournal/abstract/9900/direct_laryngoscopy_versus_video_laryngoscopy_for.382.aspx