Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
Beijing Hospital of Traditional Chinese Medicine, affiliated with Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China.
Crit Care. 2017 Nov 24;21(1):288. doi: 10.1186/s13054-017-1885-9.
There is significant controversy regarding the influence of video laryngoscopy on the intubation outcomes in emergency and critical patients. This systematic review and meta-analysis was designed to determine whether video laryngoscopy could improve the intubation outcomes in emergency and critical patients.
We searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Scopus databases from database inception until 15 February 2017. Only randomized controlled trials comparing video and direct laryngoscopy for tracheal intubation in emergency department, intensive care unit, and prehospital settings were selected. The primary outcome was the first-attempt success rate. Review Manager 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assess the quality of evidence for all outcomes.
Twelve studies (2583 patients) were included in the review for data extraction. Pooled analysis did not show an improved first-attempt success rate using video laryngoscopy (relative risk [RR], 0.93; P = 0.28; low-quality evidence). There was significant heterogeneity among studies (I = 91%). Subgroup analyses showed that, in the prehospital setting, video laryngoscopy decreased the first-attempt success rate (RR, 0.57; P < 0.01; high-quality evidence) and overall success rate (RR, 0.58; 95% CI, 0.48-0.69; moderate-quality evidence) by experienced operators, whereas in the in-hospital setting, no significant difference between two devices was identified for the first-attempt success rate (RR, 1.06; P = 0.14; moderate-quality evidence), regardless of the experience of the operators or the types of video laryngoscopes used (P > 0.05), although a slightly higher overall success rate was shown (RR, 1.11; P = 0.03; moderate-quality evidence). There were no differences between devices for other outcomes (P > 0.05), except for a lower rate of esophageal intubation (P = 0.01) and a higher rate of Cormack and Lehane grade 1 (P < 0.01) when using video laryngoscopy.
On the basis of the results of this study, we conclude that, compared with direct laryngoscopy, video laryngoscopy does not improve intubation outcomes in emergency and critical patients. Prehospital intubation is even worsened by use of video laryngoscopy when performed by experienced operators.
视频喉镜对急诊和危重症患者的插管结果的影响存在很大争议。本系统评价和荟萃分析旨在确定视频喉镜是否能提高急诊和危重症患者的插管成功率。
我们检索了 Cochrane 对照试验中心注册库、PubMed、Embase 和 Scopus 数据库，检索时间截至 2017 年 2 月 15 日。仅纳入比较在急诊科、重症监护病房和院前环境中使用视频喉镜和直接喉镜进行气管插管的随机对照试验。主要结局为首次尝试成功率。采用 Review Manager 5.3 软件进行汇总分析，并对每项合格研究的偏倚风险进行评估。采用 GRADE（推荐评估、制定与评价）系统评估所有结局的证据质量。
有 12 项研究（2583 例患者）纳入本综述进行数据提取。汇总分析显示，使用视频喉镜并不能提高首次尝试成功率（相对危险度[RR]，0.93；P=0.28；低质量证据）。研究间存在显著异质性（I²=91%）。亚组分析显示，在院前环境中，经验丰富的操作者使用视频喉镜时，首次尝试成功率（RR，0.57；P<0.01；高质量证据）和总体成功率（RR，0.58；95%CI，0.48-0.69；中等质量证据）降低，而在院内环境中，两种设备的首次尝试成功率无显著差异（RR，1.06；P=0.14；中等质量证据），无论操作者的经验或使用的视频喉镜类型如何（P>0.05），尽管总体成功率略高（RR，1.11；P=0.03；中等质量证据）。两种设备在其他结局方面无差异（P>0.05），但使用视频喉镜时，食管插管率较低（P=0.01），Cormack 和 Lehane 分级 1 较高（P<0.01）。
基于本研究结果，我们得出结论，与直接喉镜相比，视频喉镜并不能改善急诊和危重症患者的插管结果。经验丰富的操作者在院前环境中使用视频喉镜时，插管结果甚至更差。
