Royal Lancaster Infirmary, Lancaster, UK; University of Manchester, Manchester, UK.
Royal United Hospital Bath NHS Trust, Bath, UK.
Br J Anaesth. 2022 Oct;129(4):612-623. doi: 10.1016/j.bja.2022.05.027. Epub 2022 Jul 9.
Tracheal intubation is a commonly performed procedure that can be associated with complications and result in patient harm. Videolaryngoscopy (VL) may decrease this risk as compared with Macintosh direct laryngoscopy (DL). This review evaluates the risk and benefit profile of VL compared with DL in adults.
We searched MEDLINE, Embase, CENTRAL, and Web of Science on February 27, 2021. We included RCTs comparing VL with DL in patients undergoing tracheal intubation in any setting. We separately compared outcomes according to VL design: Macintosh-style, hyperangulated, and channelled.
A total of 222 RCTs (with 26 149 participants) were included. Most studies had unclear risk of bias in at least one domain, and all were at high risk of performance and detection bias. We found that videolaryngoscopes of any design likely reduce rates of failed intubation (Macintosh-style: risk ratio [RR]=0.41; 95% confidence interval [CI], 0.26-0.65; hyperangulated: RR=0.51; 95% CI, 0.34-0.76; channelled: RR=0.43, 95% CI, 0.30-0.61; moderate-certainty evidence) with increased rates of successful intubation on first attempt and better glottic views across patient groups and settings. Hyperangulated designs are likely favourable in terms of reducing the rate of oesophageal intubation, and result in improved rates of successful intubation in individuals presenting with difficult airway features (P=0.03). We also present other patient-oriented outcomes.
In this systematic review and meta-analysis of trials of adults undergoing tracheal intubation, VL was associated with fewer failed attempts and complications such as hypoxaemia, whereas glottic views were improved.
This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2022, Issue 4, DOI: 10.1002/14651858.CD011136.pub3 (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.
气管插管是一种常见的操作，但可能会导致并发症，进而给患者带来伤害。与直接喉镜（Macintosh DL）相比，视频喉镜（VL）可降低这种风险。本综述评估了 VL 与成人气管插管中 DL 相比的风险和获益情况。
我们于 2021 年 2 月 27 日检索了 MEDLINE、Embase、CENTRAL 和 Web of Science 数据库。我们纳入了在任何环境下接受气管插管的患者中比较 VL 与 DL 的 RCT。我们根据 VL 设计分别比较了结局：Macintosh 式、高角度和通道式。
共纳入 222 项 RCT（涉及 26149 名参与者）。大多数研究在至少一个领域存在不确定的偏倚风险，所有研究都存在高偏倚风险。我们发现，任何设计的 VL 都可能降低插管失败率（Macintosh 式：RR=0.41；95%CI，0.26-0.65；高角度：RR=0.51；95%CI，0.34-0.76；通道式：RR=0.43，95%CI，0.30-0.61；中确定性证据），同时首次尝试的插管成功率更高，且所有患者组和环境下的声门可视性更好。高角度设计在降低食管插管率方面可能具有优势，并且在存在困难气道特征的个体中，提高了插管成功率（P=0.03）。我们还介绍了其他以患者为导向的结局。
在这项对成人气管插管的试验进行的系统评价和荟萃分析中，VL 与较少的尝试失败和缺氧等并发症相关，而声门可视性得到改善。
本文基于发表在 Cochrane 系统评价数据库（CDSR）2022 年第 4 期的 Cochrane 综述（www.cochranelibrary.com 查看该综述的最新版本）。Cochrane 综述会根据新证据定期更新，并根据反馈进行调整，应查阅 CDSR 以获取该综述的最新版本。
