(1041) Video Versus Direct Laryngoscopy for Critically Ill Patients: A Systematic Review and Meta-Analysis

Introduction: The utilization of video laryngoscopy (VL) has demonstrated superiority over direct laryngoscopy (DL) in surgical settings. However, its effectiveness in critically ill patients remains uncertain.

Methods: We systematically searched PubMed, EMBASE, Cochrane, and ClinicalTrials.gov databases for randomized controlled trials (RCTs) comparing VL versus DL in critically ill patients. Critical settings were defined as emergency department and intensive care unit. This systematic review and meta-analysis followed Cochrane and PRISMA recommendations. We used R version 4.3.1 for statistical analysis and heterogeneity was examined with I2 statistics. Random-effect models were used.

Results: Our meta-analysis of 14 RCTs, compromising 3,974 patients assigned to VL (n=1,998) or DL (n=1,976). Compared to DL, VL significantly increased the successful intubations at first attempt (RR 1.11; 95% CI 1.04-1.19; p< 0.01; I2=81%). Regarding adverse events, VL reduced the number of esophageal intubations (RR 0.44; 95% CI 0.24-0.80; p< 0.01; I2=0%) and incidence of aspirations (RR 0.63; 95% CI 0.41-0.96; p=0.03; I2=0%) compared to DL.

Conclusions: Our findings suggest that VL is a feasible and safe strategy for increasing successful intubations at first attempt and reducing esophageal intubations and aspirations in critically ill patients. These findings support the routine use of VL in critically ill patients.