Videolaryngoscopy vs. direct laryngoscopy in orotracheal intubation in obese critical patients: Systematic review and meta-analysis.

Abstract

Objective: To determine whether the use of videolaryngoscopy (VL) is more effective than direct laryngoscopy (DL) for orotracheal intubation in obese patients.

Design: This is a systematic review and meta-analysis.

Setting: A comprehensive search was conducted in five databases for studies published up to December 26, 2023, using a PICO strategy. Fifteen studies were identified for quantitative analysis and included in our meta-analysis.

Participants: The participants of the included primary studies (obese patients).

Interventions: Orotracheal intubation with videolaryngoscopy or direct laryngoscopy.

Main variables of interest: Videolaryngoscopy, direct laryngoscopy, intubation time, first--pass success rate, minor complications.

Results: No significant differences were found in intubation time between VL and DL in obese patients (MD: -4.84; 95% CI: -13.49 to 3.80; I²: 90%). In the subgroup analysis, the Airtaq technique showed a significant difference in intubation time compared to the Macintosh technique (MD: -25.29; 95% CI: -49.17 to -1.38; I²: 95%). However, no significant differences were observed in the first--pass success rate (OR: 1.58; 95% CI: 0.77-3.23; I²: 33%) or in complications such as pain (OR: 1.15; 95% CI: 0.75-1.75; I²: 0%) and voice changes (OR: 0.76; 95% CI: 0.46-1.26; I²: 0%) between the two methods.

Conclusion: There are no significant differences in intubation time, first--pass success rate, or complications between VL and DL in obese critical patients.