The Impact of Video Laryngoscopy Versus Direct Laryngoscopy on First-Pass Intubation Success Rates in the Intensive Care Unit: A Systematic Review
DOI:
https://doi.org/10.65759/cxbqmw41Keywords:
video laryngoscopy, direct laryngoscopy, first-pass success, endotracheal intubation, intensive care unitAbstract
Background: Endotracheal intubation in the intensive care unit is a high-risk procedure because critically ill patients frequently have hypoxemia, shock, acidosis, full stomach risk, limited physiologic reserve, and urgent airway indications. First-pass intubation success is clinically important because repeated laryngoscopy attempts increase airway trauma, oxygen desaturation, aspiration risk, esophageal intubation, and hemodynamic deterioration. Video laryngoscopy improves indirect glottic visualization, while direct laryngoscopy remains widely used because of cost, availability, familiarity, and speed in trained hands. Objective: This systematic review evaluated the impact of video laryngoscopy compared with direct laryngoscopy on first-pass intubation success in adult intensive care unit patients. Methods: A PRISMA-guided systematic review framework was used. PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library were selected as target databases. Original comparative studies involving adult critically ill or ICU patients undergoing tracheal intubation with video laryngoscopy or direct laryngoscopy were eligible. Results: Ten original studies were included in the results synthesis, including randomized trials, prospective comparative studies, and observational ICU airway studies. Most observational studies and some randomized trials favored video laryngoscopy for first-pass success, while the MACMAN and FELLOW randomized trials showed no significant first-pass advantage. The large DEVICE randomized trial showed higher first-pass success with video laryngoscopy without an increase in severe complications. Conclusion: Video laryngoscopy generally improves glottic visualization and often improves first-pass intubation success in critically ill adults, with the clearest benefit in recent large trials and in anticipated difficult airway situations.
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