To the Editor,
We read the article “Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials” by Araújo et al. [1] with great interest. Although the article is well-written, certain parts merit further discussion.
Following the authors' search strategy, our reevaluation revealed that the study omitted several randomized controlled trials (RCTs) that met the criteria, including Mo et al. [2], Shukla et al. [3], Ilbagi et al. [4], Grensemann et al. [5], Kim et al. [6], Silverberg et al. [7]. These six additional RCTs increased the total patient count to 4532, with 2276 in the video laryngoscopy (VL) group and 2256 in the direct laryngoscopy (DL) group. We extracted data from the newly included RCTs and analyzed successful intubations on the first attempt using STATA 16.0 (Stata Corp., College Station, TX, USA). The meta-analysis result suggests that VL significantly enhances the first-attempt success rate compared to DL (RR, 1.12; 95% CI 1.05, 1.19; P < 0.05) (Fig. 1).
Forest plot of the first-attempt success rate in endotracheal intubation using video laryngoscopy compared to direct laryngoscopy. VL, video laryngoscopy; DL, direct laryngoscopy; CI, confidence interval
In light of the new result regarding the first-attempt success rate, we conducted a Trial Sequential Analysis (TSA) analysis. The two-sided Type I error was set at 5%, and a power of 80% was chosen to calculate the required information size (RIS) for the analysis. The incidence in the control arm was estimated through the meta-analysis. The results showed that the blue cumulative Z-curve, created using a random-effects model, crossed the traditional and TSA boundaries and reached the RIS. Consequently, this finding confirmed the improved first-attempt success rate with VL (Fig. 2).
Trial sequential analysis (TSA) of the first-attempt success rate. The blue Z curve represents the treatment effect (pooled relative risk). Green dotted lines denote traditional boundaries, and red solid lines indicate TSA boundaries. RIS, required information size; VL, video laryngoscopy; DL, direct laryngoscopy
By expanding the sample size and increasing the number of studies, our analysis provided more comprehensive evidence-based evidence.
Availability of data and materials
Not applicable.
References
Araújo B, Rivera A, Martins S, et al. Video versus direct laryngoscopy in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2024;28(1):1. https://doi.org/10.1186/s13054-023-04727-9.
Mo C, Zhang L, Song Y, Liu W. Safety and effectiveness of endotracheal intubation in critically ill emergency patients with videolaryngoscopy. Medicine (Baltimore). 2023;102(44):e35692. https://doi.org/10.1097/md.0000000000035692.
Shukla A, Shanker R, Singh VK, Singh GP, Srivastava T. Non-channeled video laryngoscopy as an alternative to conventional laryngoscopy for intubating adult patients in the intensive care unit. Cureus. 2023;15(6): e40716. https://doi.org/10.7759/cureus.40716.
Ilbagi M, Nasr-Esfahani M. The efficacy of using video laryngoscopy on tracheal intubation by novice physicians. Iran J Otorhinolaryngol. 2021;33(114):37–44. https://doi.org/10.22038/ijorl.2020.43797.2447.
Grensemann J, Eichler L, Wang N, Jarczak D, Simon M, Kluge S. Endotracheal tube-mounted camera-assisted intubation versus conventional intubation in intensive care: a prospective, randomised trial (VivaITN). Crit Care. 2018;22(1):235. https://doi.org/10.1186/s13054-018-2152-4.
Kim JW, Park SO, Lee KR, et al. Video laryngoscopy vs. direct laryngoscopy: Which should be chosen for endotracheal intubation during cardiopulmonary resuscitation? A prospective randomized controlled study of experienced intubators. Resuscitation. 2016;105:196–202. https://doi.org/10.1016/j.resuscitation.2016.04.003.
Silverberg MJ, Li N, Acquah SO, Kory PD. Comparison of video laryngoscopy versus direct laryngoscopy during urgent endotracheal intubation: a randomized controlled trial. Crit Care Med. 2015;43(3):636–41. https://doi.org/10.1097/ccm.0000000000000751.
Acknowledgements
Not applicable.
Funding
None.
Author information
Authors and Affiliations
Contributions
YZ and QW were responsible for literature research and data extraction. BZ was responsible for the figures' production. All authors participated in the discussion and wrote the manuscript.
Corresponding authors
Ethics declarations
Ethical approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Zhao, Y., Wang, Q. & Zang, B. A comparison of video laryngoscopy and direct laryngoscopy in critically ill patients. Crit Care 28, 27 (2024). https://doi.org/10.1186/s13054-024-04811-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s13054-024-04811-8