CHEST Guidelines-Video-Laryngoscopy-vs Direct-Laryngoscopy-for

Video-Laryngoscopy-vs Direct-Laryngoscopy-for

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In a correspondence regarding the meta-analysis published in CHEST by Huang et al., Feng Xu and colleagues expressed concerns over the study comparing video laryngoscopy (VL) and direct laryngoscopy (DL) for endotracheal intubation in ICU patients. The meta-analysis indicated no significant difference in first-attempt success rates between the two techniques, nor in other outcomes like intubation time and mortality rate. Xu et al. highlighted the high heterogeneity in the study outcomes excluding mortality, suggesting that outcome variations might be due to factors like the type of VL device used, setting, and sample size. The authors also questioned VL's lack of impact on success rates despite better glottic visualization, indicating this might relate to intubators' varying experience, as opposed to a universal advantage of either method. They referenced Buis et al.'s study, noting that proficiency with DL does not imply VL competency without experience. Xu et al. stressed the need for further large-scale studies to address a potential type II error and offer more conclusive results.<br /><br />In response, Huang et al. acknowledged Xu et al.'s points but emphasized that the heterogeneity noted was resolved by excluding data from one trial (Silverberg et al.), which didn't change the overall study outcomes in subgroup analyses. They suggested that despite better glottic visualization with VL, this did not lead to an improved first-attempt success rate or secondary outcomes, potentially due to factors beyond just visualization, such as operator skill and experience, which weren’t uniformly accounted for across the analyzed studies. Overall, the exchange highlights an ongoing debate over the practical advantages of VL versus DL in ICU environments, stressing the complexity of measuring intubation success beyond initial visualization ease.

Keywords

meta-analysis

video laryngoscopy

direct laryngoscopy

endotracheal intubation

ICU patients

first-attempt success

heterogeneity

glottic visualization

operator skill

large-scale studies