Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis

This meta-analysis was performed to determine whether an indirect laryngoscope is more advantageous than a direct laryngoscope for tracheal intubation in the setting of a difficult pediatric airway. Data on the intubation failure and intubation time during tracheal intubation were extracted from pro...

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Bibliographic Details
Published in:Children (Basel) 2024-01, Vol.11 (1), p.60
Main Authors: Takeuchi, Risa, Hoshijima, Hiroshi, Mihara, Takahiro, Kokubu, Shinichi, Sato Boku, Aiji, Nagumo, Takumi, Mieda, Tsutomu, Shiga, Toshiya, Mizuta, Kentaro
Format: Article
Language:English
Subjects:
Age
Analysis
Children
difficult airway
direct laryngoscopes
Esophagus
Handbooks
Health aspects
indirect laryngoscopes
Intubation
Laryngoscopy
Meta-analysis
pediatric
Pediatrics
Success
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Description
Summary:This meta-analysis was performed to determine whether an indirect laryngoscope is more advantageous than a direct laryngoscope for tracheal intubation in the setting of a difficult pediatric airway. Data on the intubation failure and intubation time during tracheal intubation were extracted from prospective and retrospective studies identified through a comprehensive literature search. Data from 10 individual articles (11 trials) were combined, and a DerSimonian and Laird random-effects model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) and the corresponding 95% confidence interval (CI). Meta-analysis of the 10 articles indicated that the intubation failure of tracheal intubation with an indirect laryngoscope was not significantly different from that of a direct laryngoscope in patients with a difficult airway (RR 0.86, 95% CI 0.51-1.46; = 0.59; Cochrane's Q = 50.5; I = 82%). Intubation time with an indirect laryngoscope was also similar to that with a direct laryngoscope (WMD 4.06 s; 95% CI -1.18-9.30; = 0.13; Cochrane's Q 39.8; I = 85%). In conclusion, indirect laryngoscopes had the same intubation failure and intubation time as direct laryngoscopes in pediatric patients with a difficult airway. Currently, the benefits of indirect laryngoscopes have not been observed in the setting of a difficult pediatric airway.
ISSN:2227-9067
2227-9067
DOI:10.3390/children11010060