Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis
Abstract
:1. Introduction
2. Methods
2.1. Protocol and Registration
2.2. Search Strategy
2.3. Study Selection and Data Collection
2.4. Eligibility Criteria
2.5. Risk of Bias within Individual Studies
2.6. Certainty of Evidence
2.7. Publication Bias
2.8. Sensitivity Analysis
2.9. Subgroup Analysis
2.10. Statistical Analysis
3. Results
3.1. Characteristics of the Studies in the Meta-Analysis
3.2. Risk of Bias
3.3. Primary Outcome
Intubation Failure at First Attempt
3.4. Secondary Outcome
Glottic Visualization and Intubation Time
3.5. Sensitivity Analysis
3.6. Subgroup Analyses
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author | Year | Type of Laryngoscopes | Number of Participants | Patients Age or Weight | ASA-PS | Airway Condition | |
---|---|---|---|---|---|---|---|
1 | Hajiyeva K | 2021 | Macintosh | 28 | 10–40 kg | Ⅰ–Ⅲ | Normal |
C-MAC | 28 | ||||||
2 | Manirajan M | 2020 | Macintosh | 39 | 0–1 y | Ⅰ–Ⅱ | Normal |
King Vision | 39 | ||||||
3 | Couto TB | 2020 | Macintosh | 141 | 1–19 y | N/A | Difficult (Emergency department) |
McGrath | 50 | ||||||
4 | Yi IK | 2019 | Macintosh | 68 | 1–10 y | Ⅰ–Ⅱ | Normal |
AWS | 68 | ||||||
5 | Tao B | 2019 | Macintosh | 35 | ≦28 d | Ⅰ–Ⅱ | No limitation |
Glidescope | 35 | ||||||
6 | Pangasa N | 2019 | Macintosh | 25 | 2–8 y | Ⅰ–Ⅱ | Normal |
Truview EVO2 | 25 | ||||||
7 | Salama ER | 2019 | Miller | 30 | ≦28 d | Ⅰ–Ⅱ | Normal |
Glidescope | 30 | ||||||
8 | Okumura Y | 2019 | Macintosh | 20 | 3–11 m | Ⅰ | Normal |
AWS | 20 | ||||||
9 | Kılınç L | 2019 | Macintosh | 40 | 1–12 y | Ⅰ–Ⅱ | Normal |
Glidescope | 40 | ||||||
10 | Yoo JY | 2018 | Macintosh | 36 | 1–10 y | Ⅰ–Ⅱ | Normal |
AWS | 35 | ||||||
McGrath | 35 | ||||||
11 | Orozco JA | 2018 | Macintosh | 40 | 2–8 y | Ⅰ–Ⅱ | Normal |
AWS | 40 | ||||||
12 | Kim JE | 2018 | Macintosh | 42 | 1–10 y | Ⅰ–Ⅱ | Normal |
McGrath | 42 | ||||||
13 | Jain D | 2018 | Miller | 32 | <1 y | Ⅰ–Ⅲ | Difficult (lateral position) |
C-MAC | 31 | ||||||
14 | Vadi MG | 2017 | Miller | 31 | 2–24 m | Ⅰ–Ⅲ | Difficult (MILS) |
Glidescope | 31 | ||||||
Storz DCI | 31 | ||||||
15 | Singh R | 2017 | Macintosh | 50 | 1–6 y | Ⅰ–Ⅱ | No limitation |
C-MAC | 50 | ||||||
Truview PCD | 50 | ||||||
16 | Konoike Y | 2017 | Miller | 29 | 1.7–6 y | Ⅰ–Ⅱ | Normal |
AWS | 30 | ||||||
McGrath | 31 | ||||||
17 | Jagannathan N | 2017 | Miller | 100 | <2 y | N/A | Normal |
King Vision | 100 | ||||||
18 | Giraudon A | 2017 | Macintosh | 67 | 10–20 kg | Ⅰ–Ⅱ | Normal |
McGrath | 65 | ||||||
19 | Das B | 2017 | Miller | 30 | 2–10 y | Ⅰ–Ⅱ | Normal |
Airtraq | 30 | ||||||
20 | Patil VV | 2016 | Macintosh | 30 | 8–18 y | Ⅰ–Ⅱ | Normal |
C-MAC | 30 | ||||||
21 | Riveros R | 2013 | Macintosh | 45 | 0–10 y | Ⅰ–Ⅲ | Normal |
Glidescope | 44 | ||||||
Truview PCD | 45 | ||||||
22 | Kaufmann J | 2013 | Glidescope | 47 | <7 y | Ⅱ | Normal |
Bonfils | 44 | ||||||
23 | Ali QE | 2013 | Macintosh | 17 | 1–5 y | Ⅰ–Ⅱ | Normal |
Airtraq | 17 | ||||||
24 | White MC | 2012 | Macintosh | 30 | 0–6 m, 6 m–6 y | Ⅰ–Ⅱ | Normal |
Airtraq | 30 | ||||||
25 | Valatten A | 2012 | Macintosh | 25 | ≦5 y | N/A | Normal |
Airtraq | 24 | ||||||
26 | Riad W | 2012 | Macintosh | 25 | 2–10 y | Ⅰ | Normal |
Airtraq | 25 | ||||||
27 | Fiadjoe JE | 2012 | Macintosh | 30 | ≦12 y | Ⅰ–Ⅱ | Normal |
Glidescope | 30 | ||||||
28 | Kim HJ | 2011 | Macintosh | 40 | <10 y | Ⅰ–Ⅱ | Normal |
Glidescope | 40 | ||||||
29 | Nileshwar A | 2010 | Macintosh | 20 | 2–10 y | Ⅰ–Ⅱ | Normal |
Bullard | 20 | ||||||
30 | Inal MT | 2010 | Miller | 25 | 2–8 y | N/A | N/A |
Truview EVO2 | 25 | ||||||
31 | Sihgh R | 2009 | Miller | 30 | 1–10 kg | N/A | N/A |
Truview EVO2 | 30 | ||||||
32 | Redel A | 2009 | Macintosh | 30 | 7 m–10 y | Ⅰ–Ⅲ | Normal |
Glidescope | 30 | ||||||
33 | Macnair D | 2009 | Macintosh | 30 | 2–16 y | Ⅰ–Ⅱ | Normal |
Storz DCI | 30 | ||||||
34 | Kim JT | 2008 | Macintosh | 100 | 3 m–17 y | N/A | No limitation |
Glidescope | 103 |
Patients: pediatric patients who received tracheal intubation | ||||
Interventions: indirect laryngoscope, miller laryngoscope | ||||
Comparator (reference): macintosh laryngoscope | ||||
Outcome: failure of tracheal intubation at first attempt | ||||
Setting: elective surgery | ||||
Total studies: 31 RCT Total Participants: 1930 | Relative effect (95% CI) | Certainty of evidence | Reasons for downgrading | P score |
Airtraq (1 RCT; 34 participants) | 0.27 (0.04–1.61) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.90 |
Airway scope (2 RCT; 137 participants) | 0.50 (0.16–1.51) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.81 |
Bonfils (1 RCT; 84 participants) | 1.08 (0.10–11.3) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.57 |
Bullard (1 RCT; 40 participants) | 19.0 (0.91–398.0) | ⨁◯◯◯ Low | Risk of bias and heterogeneity | 0.08 |
C-MAC (3 RCT; 256 participants) | 1.16 (0.25–5.45) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.55 |
Glidescope (5 RCT; 408 participants) | 1.52 (0.58–4.00) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.45 |
King Vision (1 RCT; 78 participants) | 4.23 (0.43–41.5) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.23 |
Macintosh (13 RCT; 659 participants) | No estimable | Reference comparator | No estimable | 0.60 |
McGrath (3 RCT; 347 participants) | 0.55 (0.20–1.51) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.79 |
Miller (8 RCT; 594 participants) | 1.41 (0.48–4.18) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.48 |
Storz DCI (1 RCT; 62 participants) | 2.87 (0.52–15.7) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.28 |
Truview EVO2 (1 RCT; 60 participants) | 0.94 (0.09–10.2) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.60 |
Truview PCD (2 RCT; 142 participants) | 4.78 (1.11–20.6) | ⨁◯◯◯ Low | Risk of bias and imprecision | 0.17 |
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Hoshijima, H.; Mihara, T.; Kokubu, S.; Takeda, S.; Shiga, T.; Mizuta, K. Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis. Children 2022, 9, 1280. https://doi.org/10.3390/children9091280
Hoshijima H, Mihara T, Kokubu S, Takeda S, Shiga T, Mizuta K. Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis. Children. 2022; 9(9):1280. https://doi.org/10.3390/children9091280
Chicago/Turabian StyleHoshijima, Hiroshi, Takahiro Mihara, Shinichi Kokubu, Sakura Takeda, Toshiya Shiga, and Kentaro Mizuta. 2022. "Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis" Children 9, no. 9: 1280. https://doi.org/10.3390/children9091280