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Article

Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis

1
Division of Dento-Oral Anesthesiology, Graduate School of Dentistry, Tohoku University, Sendai 980-8575, Japan
2
Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama 236-0004, Japan
3
Department of Anesthesiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Japan
4
Department of Anesthesiology and Pain Medicine, International University of Health & Welfare Ichikawa Hospital, 6-1-4 Kounodai, Ichikawa 272-0827, Japan
*
Author to whom correspondence should be addressed.
Children 2022, 9(9), 1280; https://doi.org/10.3390/children9091280
Submission received: 29 July 2022 / Revised: 20 August 2022 / Accepted: 21 August 2022 / Published: 25 August 2022
(This article belongs to the Special Issue Pediatric Airway Management: Advances and Future Challenges)

Abstract

This research aimed to produce a coherent ranking of the effectiveness of intubation devices in pediatric patients using network meta-analysis (NMA). We searched the electric databases for prospective randomized studies that compared different tracheal intubation devices in pediatric patients. The primary outcome was intubation failure at the first attempt. Secondary outcomes were glottic visualization and intubation time. The statistical analysis performed used DerSimonian and Laird random-effects models. Frequentist network meta-analysis was conducted, and network plots and network league tables were produced. Subgroup analysis was performed after excluding rigid-fiberscope-type indirect laryngoscopes. Thirty-four trials comparing 13 devices were included. Most laryngoscopes had the same intubation failure rate as the Macintosh reference device. Only the Truview PCD™ had a significantly higher intubation failure rate than the Macintosh (odds ratio 4.78, 95% confidence interval 1.11–20.6) The highest-ranking laryngoscope was the Airtaq™ (P score, 0.90), and the AirwayScope™, McGrath™, and Truview EVO2™ ranked higher than the Macintosh. The Bullard™ had the lowest ranking (P score, 0.08). All laryngoscopes had the same level of glottic visualization as the Macintosh and only the C-MAC™ had a significantly shorter intubation time. Intubation time was significantly longer when using the GlideScope™, Storz DCI™, Truview PCD™, or Bullard™ compared with the Macintosh. P score and ranking of devices in the subgroup analyses were similar to those in the main analysis. We applied NMA to create a consistent ranking of the effectiveness of intubation devices in pediatric patients. The findings of NMA suggest that there is presently no laryngoscope superior to the Macintosh laryngoscope in terms of tracheal intubation failure rate and glottic visualization in pediatric patients.
Keywords: indirect laryngoscopes; direct laryngoscopes; pediatric; network meta-analysis indirect laryngoscopes; direct laryngoscopes; pediatric; network meta-analysis

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MDPI and ACS Style

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

AMA Style

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 Style

Hoshijima, 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

APA Style

Hoshijima, H., Mihara, T., Kokubu, S., Takeda, S., Shiga, T., & Mizuta, K. (2022). Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis. Children, 9(9), 1280. https://doi.org/10.3390/children9091280

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