open access

Vol 7, No 1 (2022)
Research paper
Published online: 2022-03-18
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Video-assisted versus macintosh direct laryngoscopy for intubation of obese patients: a meta-analysis of randomized controlled trials

Togay Evrin1, Lukasz Szarpak1, Burak Katipoglu1, Nataliia Mishyna2, Burce Serra Kockan3, Kurt Ruetzler4, Martin Schläpfer5
·
Disaster Emerg Med J 2022;7(1):30-40.
Affiliations
  1. Department of Emergency Medicine, Ufuk University Medical Faculty, Ankara, Turkey
  2. Emergency Department, Universum Clinic, Kyiv, Ukraine
  3. Department of Emergency Medicine, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
  4. Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
  5. Anesthesia Institute, University Hospital Zürich, Zürich, Schwitzerland

open access

Vol 7, No 1 (2022)
ORIGINAL ARTICLES
Published online: 2022-03-18

Abstract

INTRODUCTION: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the usefulness of video-assisted (VL) approaches with the Macintosh direct laryngoscope for endotracheal intubation of obese patients.
MATERIAL AND METHODS: Studies were obtained via a systematic search of SCOPUS, Medline, Web of Science, CINAHL, and the Cochrane Central databases. The polled relative risks (RRs) odds ratios (ODs) or standard mean differences (SMD) with 95% confidence intervals (CIs) were calculated with a random–effects model. Subgroup analyses were performed to evaluate the influence of VL types on the association.
RESULTS: First intubation attempt success rate in VL and DL group varied and amounted to 94.7% vs 89.5% respectively (OR = 2.04; 95% CI: 1.21–3.42; p = 0.007) and overall intubation success rate was 99.0% vs 97.5% respectively (OR = 2.20; 95% CI: 0.45–10.67; p = 0.33). Intubation time which was 48.0 ± 37.7 for VL and 48.4 ± 37.5 seconds for DL (SMD = 0.14; 95% CI: –0.33–0.61; p = 0.56). Cormack-Lehane 1 or 2 grade during intubation using VL was observed in 95.9% of cases and was statistically significantly higher than in the case of direct laryngoscopy (79.6%; OR = 6.68; 95% CI: 3.32–13.42; p < 0.001).
CONCLUSIONS: Our meta-analysis suggests that video-assisted intubation may be superior to conventional intubation in an obese patient population due to a higher first–attempt success rate, better glottis visibility, and a lower rate of intubation-related injuries.

Abstract

INTRODUCTION: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the usefulness of video-assisted (VL) approaches with the Macintosh direct laryngoscope for endotracheal intubation of obese patients.
MATERIAL AND METHODS: Studies were obtained via a systematic search of SCOPUS, Medline, Web of Science, CINAHL, and the Cochrane Central databases. The polled relative risks (RRs) odds ratios (ODs) or standard mean differences (SMD) with 95% confidence intervals (CIs) were calculated with a random–effects model. Subgroup analyses were performed to evaluate the influence of VL types on the association.
RESULTS: First intubation attempt success rate in VL and DL group varied and amounted to 94.7% vs 89.5% respectively (OR = 2.04; 95% CI: 1.21–3.42; p = 0.007) and overall intubation success rate was 99.0% vs 97.5% respectively (OR = 2.20; 95% CI: 0.45–10.67; p = 0.33). Intubation time which was 48.0 ± 37.7 for VL and 48.4 ± 37.5 seconds for DL (SMD = 0.14; 95% CI: –0.33–0.61; p = 0.56). Cormack-Lehane 1 or 2 grade during intubation using VL was observed in 95.9% of cases and was statistically significantly higher than in the case of direct laryngoscopy (79.6%; OR = 6.68; 95% CI: 3.32–13.42; p < 0.001).
CONCLUSIONS: Our meta-analysis suggests that video-assisted intubation may be superior to conventional intubation in an obese patient population due to a higher first–attempt success rate, better glottis visibility, and a lower rate of intubation-related injuries.

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Keywords

video-laryngoscope, direct-laryngoscope, endotracheal intubation, obese, intubation attempt, intubation time, meta-analysis

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Title

Video-assisted versus macintosh direct laryngoscopy for intubation of obese patients: a meta-analysis of randomized controlled trials

Journal

Disaster and Emergency Medicine Journal

Issue

Vol 7, No 1 (2022)

Article type

Research paper

Pages

30-40

Published online

2022-03-18

Page views

4927

Article views/downloads

320

DOI

10.5603/DEMJ.a2022.0004

Bibliographic record

Disaster Emerg Med J 2022;7(1):30-40.

Keywords

video-laryngoscope
direct-laryngoscope
endotracheal intubation
obese
intubation attempt
intubation time
meta-analysis

Authors

Togay Evrin
Lukasz Szarpak
Burak Katipoglu
Nataliia Mishyna
Burce Serra Kockan
Kurt Ruetzler
Martin Schläpfer

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