Zaki Hany A, Shaban Eman, Elgassim Mohamed, Fayed Mohamed, Basharat Kaleem, Elnabawy Wael, Abdelrahim Mohammed Gafar, Elkandow Ali, Mahdy Ahmed, Azad Aftab
Emergency Medicine, Hamad Medical Corporation, Doha, QAT.
Cardiology, Al Jufairi Diagnostic and Treatment, Doha, QAT.
Cureus. 2023 Dec 17;15(12):e50648. doi: 10.7759/cureus.50648. eCollection 2023 Dec.
Since the 1940s, Macintosh laryngoscopy (Mac laryngoscopy) has been the gold standard for tracheal intubation, offering visualization of the glottis entrance. However, recent years have witnessed the emergence of various video laryngoscopy (VL) techniques. This systematic review and meta-analysis aims to assess the clinical outcomes of VL Mac laryngoscopy in an elective setting. We comprehensively searched five medical databases - PubMed, EMBASE, Medline, Cochrane Library, and Web of Science. All the databases were last searched in January 2023. We only included studies with full texts comparing VL to Mac laryngoscopy clinical outcomes. Studies were excluded if they were non-full text or non-randomized controlled trials (RCTs) and did not compare VL to Mac laryngoscopy. We extracted data comprising author names, publication year, key study outcomes (first-attempt intubation success rate, Cormack and Lehane grade, hypoxia incidence, and glottis view quality), video laryngoscope types, and sample sizes of both VL and Mac laryngoscopy groups. The Cochrane risk of bias tool was used to assess the risk of bias in the included studies. Statistical analysis was performed using Review Manager (RevMan, version 5.4; Cochrane Collaboration, London, UK), presenting results as odds ratio (OR) and risk ratios (RR) at a 95% confidence interval (CI). This facilitated the identification of relevant and appropriate studies of our analysis. The search produced 19 studies that were included in this review. The evaluated sample size ranges from 40 to 802, with 3,238 participants. The rate of success at the first attempt in the use of VL was 1,558/1,890 (82.43%), while the success rate for Mac laryngoscopy was 982/1,348 (72.85%; OR: 1.98 (1.25, 3.12)) at a 95% confidence interval. Pooled analysis indicated no significant difference for hypoxia concerning the type of device used RR (random effects: 1.02; 95% CI: 0.80-1.29). A video laryngoscope had a higher likelihood of visualizing the vocal cords categorized as category 1 in the Cormack-Lehane system of classification (RR: 2.45; 95% CI: 1.43-4.21). Additionally, considerably better glottis views were attained during VL than Mac laryngoscopy (OR: 1.77; 95% CI: 1.19-2.62). In elective tracheal intubation, VL demonstrates superior first-attempt success rates, offers improved glottis visualization, and reduces instances where the glottis cannot be viewed compared to Mac laryngoscopy.
自20世纪40年代以来，麦金托什喉镜检查（Mac喉镜检查）一直是气管插管的金标准，可实现声门入口的可视化。然而，近年来出现了各种视频喉镜（VL）技术。本系统评价和荟萃分析旨在评估在择期情况下VL与Mac喉镜检查的临床结果。我们全面检索了五个医学数据库——PubMed、EMBASE、Medline、Cochrane图书馆和Web of Science。所有数据库最后一次检索时间为2023年1月。我们仅纳入了比较VL与Mac喉镜检查临床结果的全文研究。如果研究为非全文或非随机对照试验（RCT）且未比较VL与Mac喉镜检查，则将其排除。我们提取的数据包括作者姓名、出版年份、关键研究结果（首次尝试插管成功率、科马克和莱汉分级、低氧发生率和声门视野质量）、视频喉镜类型以及VL组和Mac喉镜检查组的样本量。使用Cochrane偏倚风险工具评估纳入研究的偏倚风险。使用Review Manager（RevMan，版本5.4；英国伦敦Cochrane协作网）进行统计分析，结果以95%置信区间（CI）的优势比（OR）和风险比（RR）表示。这有助于识别我们分析中相关且合适的研究。检索结果产生了19项纳入本评价的研究。评估的样本量范围为40至802，共有3238名参与者。使用VL时首次尝试的成功率为1558/1890（82.43%），而Mac喉镜检查的成功率为982/1348（72.85%；OR：1.98（1.25，3.12）），95%置信区间。汇总分析表明，关于所用设备类型，低氧方面无显著差异，RR（随机效应）：1.02；95%CI：0.80 - 1.29。在科马克 - 莱汉分类系统中，视频喉镜将声带可视化为1类的可能性更高（RR：2.45；95%CI：1.43 - 4.21）。此外，与Mac喉镜检查相比，VL期间获得的声门视野明显更好（OR：1.77；95%CI：1.19 - 2.62）。在择期气管插管中，与Mac喉镜检查相比，VL显示出更高的首次尝试成功率，提供了更好的声门可视化效果，并减少了无法看到声门的情况。
