Jiang Jia, Ma Da-Xu, Li Bo, Wu An-Shi, Xue Fu-Shan
Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Beijing Hospital of Traditional Chinese Medicine, Affiliated to Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China.
Ther Clin Risk Manag. 2018 Oct 15;14:1955-1963. doi: 10.2147/TCRM.S172783. eCollection 2018.
Awake intubation with videolaryngoscopy (VL) is a novel method that is drawing more and more attention as an alternative to awake intubation with fiberoptic bronchoscope (FOB). This meta-analysis is designed to determine the performance of VL compared to the FOB for awake intubation.
The Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web of science were searched from database inception until October 30, 2017. Randomized controlled trials comparing VL and FOB for awake intubation were selected. The primary outcome was the overall success rate. Rev-Man 5.3 software was used to perform the pooled analysis and assess the risk of bias for each eligible study. The GRADE system was used to assess the quality of evidence for all outcomes.
Six studies (446 patients) were included in the review for data extraction. Pooled analysis did not show any difference in the overall success rate by using VL and FOB (relative risk [RR], 1.00; =0.99; high-quality evidence). There was no heterogeneity among studies ( =0). Subgroup analyses showed no differences between two groups through nasal (RR, 1.00; =1.00; high-quality evidence) and oral intubations (RR, 1.00; =0.98; high-quality evidence). The intubation time was shorter by using VL than by using FOB (mean difference, -40.4 seconds; <0.01; low-quality evidence). There were no differences between groups for other outcomes (>0.05).
For awake intubation, VL with a shorter intubation time is as effective and safe as FOB. VL may be a useful alternative to FOB.
视频喉镜清醒插管（VL）是一种新型方法，作为纤维支气管镜（FOB）清醒插管的替代方法正受到越来越多的关注。本荟萃分析旨在确定与FOB相比，VL用于清醒插管的性能。
检索Cochrane对照试验中央登记库、PubMed、Embase和Web of science，检索时间从数据库建立至2017年10月30日。选择比较VL和FOB用于清醒插管的随机对照试验。主要结局是总体成功率。使用Rev-Man 5.3软件进行汇总分析，并评估每项合格研究的偏倚风险。采用GRADE系统评估所有结局的证据质量。
纳入6项研究（446例患者）进行数据提取。汇总分析显示，使用VL和FOB的总体成功率无差异（相对危险度[RR]，1.00；95%置信区间[CI]，0.99；高质量证据）。各研究间无异质性（I² = 0）。亚组分析显示，经鼻插管（RR，1.00；95%CI，1.00；高质量证据）和经口插管（RR，1.00；95%CI，0.98；高质量证据）两组间无差异。使用VL的插管时间比使用FOB的短（平均差，-40.4秒；P < 0.01；低质量证据）。其他结局两组间无差异（P > 0.05）。
对于清醒插管，插管时间较短的VL与FOB一样有效和安全。VL可能是FOB的一种有用替代方法。
