Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis

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Title:	Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis
Authors:	Chen, I-Wen Li, Yu-Yu Hung, Kuo-Chuan Chang, Ying-Jen Chen, Jen-Yin Lin, Ming-Chung Wang, Kuei-Fen Lin, Chien-Ming Huang, Ping-Wen Sun, Cheuk-Kwan
Contributors:	Chi Mei Hospital Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science Show Chwan Memorial Hospital E-Da Hospital I Shou University
Keywords:	tracheal intubation macintosh laryngoscope difficult airway mcgrath videolaryngoscope orotracheal intubation management fiberscope motion blade risk
Date:	2022
Issue Date:	2023-12-11 14:02:15 (UTC+8)
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Abstract:	Background: Although minimization of cervical spine motion by using a neck collar or manual in-line stabilization is recommended for urgent tracheal intubation (TI) in patients with known or suspected cervical spine injury (CSI), it may worsen glottic visualization. The overall performance of video-stylets during TI in patients with neck immobilization remains unclear. The current meta-analysis aimed at comparing the intubation outcomes of different video-stylets with those of conventional laryngoscopes in patients with cervical immobilization. Method: The databases of Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched from inception to June 2021 to identify trials comparing intubation outcomes between video-stylets and conventional laryngoscopes. The primary outcome was first-pass success rate, while secondary outcomes included overall success rate, time to intubation, the risk of intubation-associated sore throat, or tissue damage. Results: Five randomized controlled trials published between 2007 and 2013 involving 487 participants, all in an operating room setting, were analyzed. The video-stylets investigated included Bonfils intubation fiberscope, Levitan FPS Scope, and Shikani optical stylet. There was no difference in first-pass success rate (risk ratio [RR] =1.08, 95% confidence interval [CI]: 0.89-1.31, P = .46], overall success rate (RR = 1.06, 95% CI: 0.93-1.22, P = .4), intubation time [mean difference = 4.53 seconds, 95% CI: -8.45 to 17.51, P = .49), and risk of tissue damage (RR = 0.46, 95% CI: 0.16-1.3, P = .14) between the 2 groups. The risk of sore throat was lower with video-stylets compared to that with laryngoscopes (RR = 0.45, 95% CI: 0.23-0.9, P = .02). Conclusion: Our results did not support the use of video-stylets as the first choice for patients with neck immobilization. Further studies are required to verify the efficacy of video-stylets in the nonoperating room setting.
Relation:	MEDICINE, v.101, n.33, e30032
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles

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