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Investigators concluded that in critically ill patients, video laryngoscopy outperformed traditional direct laryngoscopy for first-attempt success and reducing esophageal intubations.

The following is a summary of “Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials,” published in the January 2024 issue of Critical Care by Araújo et al.

Researchers performed a retrospective study to investigate the potential benefits of video laryngoscopy (VL) compared to traditional direct laryngoscopy (DL) in emergency intubation procedures within intensive care units and emergency departments.

They systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for RCTs (randomized controlled trials) comparing VL versus DL in critically ill patients. The critical setting, defined as the emergency department and intensive care unit, was included. Following Cochrane and PRISMA recommendations, a systematic review and meta-analysis were performed. R version 4.3.1 conducted a statistical analysis using I² for heterogeneity and applied random-effect models to all outcomes.

The results showed 14 RCTs, with 3981 patients assigned to VL (n = 2002) or DL (n = 1979). VL notably improved successful intubations on the first attempt compared to DL (RR 1.12; 95% CI 1.04–1.20; P<0.01; I² = 82%). In terms of adverse events, VL resulted in a reduction in esophageal intubations (RR 0.44; 95% CI 0.24–0.80; P<0.01; I² = 0%) and incidence of aspiration episodes (RR 0.63; 95% CI 0.41–0.96; P=0.03; I² = 0%) compared to DL.

Investigators concluded that in critically ill patients, VL outperformed DL for first-attempt success and reducing esophageal intubations, bolstering its case for routine use.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04727-9