Lingappan Krithika, Arnold Jennifer L, Fernandes Caraciolo J, Pammi Mohan
Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street (WT 6-104), Houston, TX, USA, 77030.
Cochrane Database Syst Rev. 2018 Jun 4;6(6):CD009975. doi: 10.1002/14651858.CD009975.pub3.
Establishment of a secure airway is a critical part of neonatal resuscitation in the delivery room and the neonatal unit. Videolaryngoscopy has the potential to facilitate successful endotracheal intubation and decrease adverse consequences of delay in airway stabilization. Videolaryngoscopy may enhance visualization of the glottis and intubation success in neonates.
To determine the efficacy and safety of videolaryngoscopy compared to direct laryngoscopy in decreasing the time and attempts required for endotracheal intubation and increasing the success rate at first intubation in neonates.
We used the search strategy of Cochrane Neonatal. In May 2017, we searched for randomized controlled trials (RCT) evaluating videolaryngoscopy for neonatal endotracheal intubation in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, abstracts of the Pediatric Academic Societies, websites for registered trials at www.clinicaltrials.gov and www.controlled-trials.com, and reference lists of relevant studies.
RCTs or quasi-RCTs in neonates evaluating videolaryngoscopy for endotracheal intubation compared with direct laryngoscopy.
Review authors performed data collection and analysis as recommended by Cochrane Neonatal. Two review authors independently assessed studies identified by the search strategy for inclusion.We used the GRADE approach to assess the quality of evidence.
The search yielded 7057 references of which we identified three RCTs for inclusion, four ongoing trials and one study awaiting classification. All three included RCTs compared videolaryngoscopy with direct laryngoscopy during intubation attempts by trainees.Time to intubation was similar between videolaryngoscopy and direct laryngoscopy (mean difference (MD) -0.62, 95% confidence interval (CI) -6.50 to 5.26; 2 studies; 311 intubations) (very low quality evidence). Videolaryngoscopy did not decrease the number of intubation attempts (MD -0.05, 95% CI -0.18 to 0.07; 2 studies; 427 intubations) (very low quality evidence). Moderate quality evidence suggested that videolaryngoscopy increased the success of intubation at first attempt (typical risk ratio (RR) 1.44, 95% CI 1.20 to 1.73; typical risk difference (RD) 0.19, 95% CI 0.10 to 0.28; number needed to treat for an additional beneficial outcome (NNTB) 5, 95% CI 4 to 10; 3 studies; 467 intubation attempts).Desaturation episodes during intubation attempts were similar between videolaryngoscopy and direct laryngoscopy (MD -0.76, 95% CI -5.74 to 4.23; 2 studies; 359 intubations) (low quality evidence). There was no difference in the incidence of airway trauma due to intubation attempts (RR 0.10, 95% CI 0.01 to 1.80; RD -0.04, 95% CI -0.09 to -0.00; 1 study; 213 intubations) (low quality evidence).There were no data available on other adverse effects of videolaryngoscopy.
AUTHORS' CONCLUSIONS: Moderate to very low quality evidence suggests that videolaryngoscopy increases the success of intubation in the first attempt but does not decrease the time to intubation or the number of attempts for intubation. However, these studies were conducted with trainees performing the intubations and these results highlight the potential usefulness of the videolaryngoscopy as a teaching tool. Well-designed, adequately powered RCTs are necessary to confirm efficacy and address safety and cost-effectiveness of videolaryngoscopy for endotracheal intubation in neonates by trainees and those proficient in direct laryngoscopy.
建立安全气道是产房和新生儿病房新生儿复苏的关键环节。视频喉镜有可能促进气管插管成功，并减少气道稳定延迟带来的不良后果。视频喉镜可能会提高新生儿声门的可视性及插管成功率。
确定与直接喉镜检查相比，视频喉镜在减少新生儿气管插管所需时间和尝试次数以及提高首次插管成功率方面的有效性和安全性。
我们采用了Cochrane新生儿组的检索策略。2017年5月，我们在Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、Embase、护理学与健康领域数据库（CINAHL）、儿科学术协会摘要、www.clinicaltrials.gov和www.controlled-trials.com上的注册试验网站以及相关研究的参考文献列表中检索了评估视频喉镜用于新生儿气管插管的随机对照试验（RCT）。
评估视频喉镜与直接喉镜用于新生儿气管插管的RCT或半随机对照试验。
综述作者按照Cochrane新生儿组的建议进行数据收集和分析。两名综述作者独立评估检索策略所识别的纳入研究。我们采用GRADE方法评估证据质量。
检索共获得7057篇参考文献，其中我们确定纳入3项RCT、4项正在进行的试验和1项等待分类的研究。所有3项纳入的RCT均比较了实习医生在插管尝试过程中视频喉镜与直接喉镜的效果。视频喉镜和直接喉镜的插管时间相似（平均差（MD）-0.62，95%置信区间（CI）-6.50至5.26；2项研究；311次插管）（极低质量证据）。视频喉镜并未减少插管尝试次数（MD -0.05，95% CI -0.18至0.07；2项研究；427次插管）（极低质量证据）。中等质量证据表明，视频喉镜提高了首次插管的成功率（典型风险比（RR）1.44，95% CI 1.20至1.73；典型风险差（RD）0.19，95% CI 0.10至0.28；为获得额外有益结果所需治疗人数（NNTB）5，95% CI 4至10；3项研究；467次插管尝试）。插管尝试期间的血氧饱和度下降情况在视频喉镜和直接喉镜之间相似（MD -0.76，95% CI -5.74至4.23；2项研究；359次插管）（低质量证据）。插管尝试导致的气道创伤发生率无差异（RR 0.10，95% CI 0.01至1.80；RD -0.04，95% CI -0.09至-0.00；1项研究；213次插管）（低质量证据）。关于视频喉镜的其他不良反应尚无可用数据。
中等至极低质量证据表明，视频喉镜可提高首次插管成功率，但并未减少插管时间或插管尝试次数。然而，这些研究是由实习医生进行插管操作的，这些结果凸显了视频喉镜作为一种教学工具的潜在用途。需要设计良好、样本量充足的RCT来证实视频喉镜对实习医生及熟练掌握直接喉镜检查者进行新生儿气管插管的有效性，并探讨其安全性和成本效益。
