Yuan Jun, Yang Penglei, Yu Lina, Zhang Wenguang, Yu Jiangquan, Chen Qihong
Department of Critical Care Medicine, Jiangdu People's Hospital Affiliated to Yangzhou University, Yangzhou, 225200, China.
Department of Emergency, Jingjiang People's Hospital, Jingjiang, 214599, China.
Eur J Med Res. 2025 Apr 15;30(1):282. doi: 10.1186/s40001-025-02525-3.
Although Video laryngoscope (VL) can reduce the difficulty of endotracheal intubation and improve the glottic view, its use in critically ill patients is controversial.
Randomized controlled trials (RCTs) of VL and direct laryngoscopy (DL) for critically ill patients were searched on electronic databases, including Web of Science, PubMed, and Embase. Additional publications were identified by screening the reference lists of the identified articles and relevant previously published reviews.
Overall, 25 RCTs involving 5836 critically ill patients were included in the analysis. There was no significant difference in the first intubation rate between the VL and DL groups (25 studies; RR, 1.03; 95% CI 0.96-1.11; n = 5836; p = 0.37; very low certainty). However, Multivariate meta-regression analysis identified two main sources of bias: whether intubation was performed in a hospital (p = 0.04) and operator proficiency with DL compared to VL (p < 0.001). Subgroup analysis showed that VL improved the first intubation rate in in-hospital intubation (19 studies; RR, 1.12; 95% CI 1.04-1.22; n = 4441; p < 0.01, very low certainty) and VL showed good potential to reduce the first-attempt intubation success rates, but not significantly (6 studies; RR, 0.75; 95% CI 0.56-1.00; n = 1395; p = 0.05, very low certainty). In subgroups with similar operator proficiency VL and DL, VL increased the success rate for first intubation (16 studies; RR, 1.14; 95% CI 1.06-1.23; n = 3,971; p < 0.01; very low certainty). However, VL decreased the first intubation rate (4 studies; RR, 0.65; 95% CI 0.49-0.88; n = 810; p < 0.01; very low certainty) in a subgroup where operator proficiency was higher for DL than for VL.
VL does not increase the first intubation rate. However, VL increases the first-attempt intubation success rate for in-hospital intubation and operators with similar proficiency in VL and DL.
尽管视频喉镜（VL）可降低气管插管难度并改善声门视野，但其在重症患者中的应用仍存在争议。
在电子数据库（包括科学网、PubMed和Embase）中检索关于VL和直接喉镜检查（DL）用于重症患者的随机对照试验（RCT）。通过筛选已识别文章的参考文献列表和先前发表的相关综述来确定其他出版物。
总体而言，分析纳入了25项涉及5836例重症患者的RCT。VL组和DL组的首次插管成功率无显著差异（25项研究；RR，1.03；95%CI 0.96 - 1.11；n = 5836；p = 0.37；极低确定性）。然而，多变量meta回归分析确定了两个主要偏倚来源：是否在医院进行插管（p = 0.04）以及与VL相比DL操作者的熟练程度（p < 0.001）。亚组分析表明，VL提高了院内插管的首次插管成功率（19项研究；RR，1.12；95%CI 1.04 - 1.22；n = 4441；p < 0.01，极低确定性），并且VL显示出降低首次尝试插管成功率的良好潜力，但差异不显著（6项研究；RR，0.75；95%CI 0.56 - 1.00；n = 1395；p = 0.05，极低确定性）。在VL和DL操作者熟练程度相似的亚组中，VL提高了首次插管成功率（16项研究；RR，1.14；95%CI 1.06 - 1.23；n = 3971；p < 0.01；极低确定性）。然而，在DL操作者熟练程度高于VL的亚组中，VL降低了首次插管成功率（4项研究；RR，0.65；95%CI 0.49 - 0.88；n = 810；p < 0.01；极低确定性）。
VL不会提高首次插管成功率。然而，VL可提高院内插管以及VL和DL熟练程度相似的操作者的首次尝试插管成功率。
