视频喉镜与直接喉镜在危重症患者中的应用：一项更新的随机对照试验的系统评价和荟萃分析。
Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of Medicine, Nove de Julho University, 90 Dom Jaime de Barros Câmara Avenue, São Bernardo do Campo, São Paulo, Brazil.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
出版信息
Crit Care. 2024 Jan 2;28(1):1. doi: 10.1186/s13054-023-04727-9.
BACKGROUND
The utilization of video laryngoscopy (VL) has demonstrated superiority over direct laryngoscopy (DL) for intubation in surgical settings. However, its effectiveness in the intensive care unit and emergency department settings remains uncertain.
METHODS
We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing VL versus DL in critically ill patients. Critical setting was defined as emergency department and intensive care unit. This systematic review and meta-analysis followed Cochrane and PRISMA recommendations. R version 4.3.1 was used for statistical analysis and heterogeneity was examined with I statistics. All outcomes were submitted to random-effect models.
RESULTS
Our meta-analysis of 14 RCTs, compromising 3981 patients assigned to VL (n = 2002) or DL (n = 1979). Compared with DL, VL significantly increased successful intubations on the first attempt (RR 1.12; 95% CI 1.04-1.20; p < 0.01; I = 82%). Regarding adverse events, VL reduced the number of esophageal intubations (RR 0.44; 95% CI 0.24-0.80; p < 0.01; I = 0%) and incidence of aspiration episodes (RR 0.63; 95% CI 0.41-0.96; p = 0.03; I = 0%) compared to DL.
CONCLUSION
VL is a more effective and safer strategy compared with DL for increasing successful intubations on the first attempt and reducing esophageal intubations in critically ill patients. Our findings support the routine use of VL in critically ill patients. Registration CRD42023439685 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023439685 . Registered 6 July 2023.
背景
视频喉镜（VL）的使用在手术环境中已被证明在插管方面优于直接喉镜（DL）。然而，其在重症监护病房和急诊科环境中的有效性仍不确定。
方法
我们系统地检索了 PubMed、Embase、Cochrane 和 ClinicalTrials.gov 数据库，以查找比较危重症患者使用 VL 与 DL 的随机对照试验（RCT）。关键设置定义为急诊科和重症监护病房。本系统评价和荟萃分析遵循 Cochrane 和 PRISMA 建议。使用 R 版本 4.3.1 进行统计分析，并使用 I 统计量检查异质性。所有结果均提交给随机效应模型。
结果
我们对 14 项 RCT 的荟萃分析，纳入了 3981 名患者，分为 VL 组（n=2002）和 DL 组（n=1979）。与 DL 相比，VL 显著增加了首次尝试插管的成功率（RR 1.12；95%CI 1.04-1.20；p<0.01；I=82%）。关于不良事件，VL 减少了食管插管的数量（RR 0.44；95%CI 0.24-0.80；p<0.01；I=0%）和误吸发作的发生率（RR 0.63；95%CI 0.41-0.96；p=0.03；I=0%），与 DL 相比。
结论
与 DL 相比，VL 是一种更有效和更安全的策略，可增加首次尝试插管的成功率，并减少危重症患者的食管插管。我们的研究结果支持在危重症患者中常规使用 VL。注册 CRD42023439685 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023439685. 于 2023 年 7 月 6 日注册。
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