Huang Yujie, Du Li, Liu Dan, Zhang Weiyi, Li Tingting, Zheng Jianqiao
West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.
Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
BMJ Open. 2025 Jun 23;15(6):e098508. doi: 10.1136/bmjopen-2024-098508.
Videolaryngoscopes are recommended as the top preference for tracheal intubation in adults, children, infants and neonates, and even in patients with anticipated difficult airways, since they are generally easier to use and quicker to master than fibreoptic bronchoscopes. Compared with standard videolaryngoscopes, hyperangulated videolaryngoscopes possess a more sharply curved blade or blade tip, resulting in a higher first-attempt success rate among patients with anticipated difficult airways. However, hyperangulated videolaryngoscopes also pose challenges in advancing the tracheal tube, which decreases the first-attempt success rate while increasing the tracheal intubation time when the tracheal tube introducer is unsuitable. Hence, controversy still remains regarding the efficiency of hyperangulated videolaryngoscopes as first-line devices in patients with anticipated difficult airways, owing to the inconsistent clinical findings. Consequently, we will conduct a protocol for a systematic review and meta-analysis to determine the usefulness of hyperangulated videolaryngoscopes in patients with anticipated difficult airways.
English-language databases (Web of Science, Cochrane Library, PubMed, Embase and Ovid Medline), Chinese electronic databases (VIP database, China National Knowledge Infrastructure, and Wanfang database) and clinical trial registry platforms will be scoured from their inception to May 2025 to locate randomised controlled trials of hyperangulated videolaryngoscopes in patients with anticipated difficult airways. For continuous data, mean differences or standardised mean differences, accompanied by their 95% CIs, and for dichotomous data, the risk ratio, accompanied by its 95% CI, will be calculated using Review Manager V.5.4. Either a fixed-effects model or a random-effects model will be used depending on the magnitude of statistical heterogeneity as evaluated via the I test. The risk of bias will be assessed via the Cochrane risk-of-bias tool 2. Additionally, the quality of evidence regarding each outcome will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation. The reliability of all outcomes will be appraised via trial sequential analysis. Moreover, the publication bias of all outcomes will be examined using Funnel plots and Egger's regression test.
Ethical approval was not required for this systematic review protocol. The results will be disseminated through peer-reviewed publications.
CRD42024627484.
视频喉镜被推荐为成人、儿童、婴儿和新生儿气管插管的首选，甚至对于预计气道困难的患者也是如此，因为与纤维支气管镜相比，它们通常更易于使用且更容易掌握。与标准视频喉镜相比，超广角视频喉镜的镜片或镜片尖端弯曲度更大，这使得预计气道困难的患者首次尝试成功率更高。然而，超广角视频喉镜在推进气管导管时也存在挑战，当气管导管导入器不合适时，这会降低首次尝试成功率并增加气管插管时间。因此，由于临床结果不一致，对于超广角视频喉镜作为预计气道困难患者一线设备的效率仍存在争议。因此，我们将制定一项系统评价和荟萃分析方案，以确定超广角视频喉镜在预计气道困难患者中的实用性。
将检索英文数据库（科学网、考克兰图书馆、PubMed、Embase和Ovid Medline）、中文电子数据库（维普数据库、中国知网和万方数据库）以及临床试验注册平台，检索时间从各数据库建库至2025年5月，以查找关于超广角视频喉镜在预计气道困难患者中的随机对照试验。对于连续性数据，将使用Review Manager V.5.4计算平均差或标准化平均差及其95%置信区间，对于二分数据，将计算风险比及其95%置信区间。将根据通过I检验评估的统计异质性大小，使用固定效应模型或随机效应模型。将通过Cochrane偏倚风险工具2评估偏倚风险。此外，将使用推荐分级评估、制定和评价方法评估每个结局的证据质量。将通过试验序贯分析评估所有结局的可靠性。此外，将使用漏斗图和Egger回归检验检查所有结局的发表偏倚。
本系统评价方案无需伦理批准。研究结果将通过同行评审出版物进行传播。
PROSPERO注册号：CRD42024627484。
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