视频喉镜与直接喉镜在婴儿和新生儿中的应用：一项系统综述和荟萃分析

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-09-25 DOI:10.1016/j.jclinane.2025.112024

Issa Salha MD , Paweł Łajczak , Yasmin Picanco Silva MD , Sana Ahmed , Thaïmye Joseph , Oguz Kagan Sahin , Railla Silva , Rafaela Machado Filardi MD

{"title":"视频喉镜与直接喉镜在婴儿和新生儿中的应用：一项系统综述和荟萃分析","authors":"Issa Salha MD , Paweł Łajczak , Yasmin Picanco Silva MD , Sana Ahmed , Thaïmye Joseph , Oguz Kagan Sahin , Railla Silva , Rafaela Machado Filardi MD","doi":"10.1016/j.jclinane.2025.112024","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Endotracheal intubation in infants and neonates is a critical yet challenging procedure with a narrow time window. This meta-analysis aimed to compare video laryngoscopy (VL) to direct laryngoscopy (DL) regarding first-attempt success, time to intubation, and complication rates.</div></div><div><h3>Methods</h3><div>We searched PubMed, Cochrane, and Embase databases and conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published up to June 2024, comparing VL and DL in infants less than one-year-old and neonates (defined as infants 0–28 days old). Primary outcomes included first-attempt success rate, while secondary outcomes were time to intubation (TTI) and complication rates. A subgroup analysis was performed for neonates.</div></div><div><h3>Results</h3><div>In our analysis of 17 RCTs with 1918 participants, VL demonstrated a higher first-attempt success rate compared to DL (87.5 % vs 78 %; OR 2.13; <em>p</em> < 0.001), with similar results in neonates (77.6 % vs 63 %; OR 2.12; <em>p</em> = 0.027). VL also improved the time to best view (MD -2.85; <em>p</em> < 0.01) and showed significantly better POGO scores (MD 16.8; p < 0.01). However, there was no advantage of VL over DL in reducing time to intubation (MD 0.79; <em>p</em> = 0.49). VL reduced complications compared to DL (2.77 % vs 8.44 %; OR 0.33; <em>p</em> = 0.022).</div></div><div><h3>Conclusions</h3><div>This meta-analysis suggests that VL may improve first-attempt success and glottic visualization and may reduce complications compared with DL in infants and neonates. Intubation times appear similar between the two approaches. However, moderate heterogeneity, variability in VL devices, and potential operator dependence indicate that these findings should be interpreted with caution. Further clinical trials are warranted to validate these results and explore the long-term implications of VL on patient outcomes.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"Article 112024"},"PeriodicalIF":5.1000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Video laryngoscopy vs. direct laryngoscopy in infants and neonates: A systematic review and meta-analysis\",\"authors\":\"Issa Salha MD , Paweł Łajczak , Yasmin Picanco Silva MD , Sana Ahmed , Thaïmye Joseph , Oguz Kagan Sahin , Railla Silva , Rafaela Machado Filardi MD\",\"doi\":\"10.1016/j.jclinane.2025.112024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Endotracheal intubation in infants and neonates is a critical yet challenging procedure with a narrow time window. This meta-analysis aimed to compare video laryngoscopy (VL) to direct laryngoscopy (DL) regarding first-attempt success, time to intubation, and complication rates.</div></div><div><h3>Methods</h3><div>We searched PubMed, Cochrane, and Embase databases and conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published up to June 2024, comparing VL and DL in infants less than one-year-old and neonates (defined as infants 0–28 days old). Primary outcomes included first-attempt success rate, while secondary outcomes were time to intubation (TTI) and complication rates. A subgroup analysis was performed for neonates.</div></div><div><h3>Results</h3><div>In our analysis of 17 RCTs with 1918 participants, VL demonstrated a higher first-attempt success rate compared to DL (87.5 % vs 78 %; OR 2.13; <em>p</em> < 0.001), with similar results in neonates (77.6 % vs 63 %; OR 2.12; <em>p</em> = 0.027). VL also improved the time to best view (MD -2.85; <em>p</em> < 0.01) and showed significantly better POGO scores (MD 16.8; p < 0.01). However, there was no advantage of VL over DL in reducing time to intubation (MD 0.79; <em>p</em> = 0.49). VL reduced complications compared to DL (2.77 % vs 8.44 %; OR 0.33; <em>p</em> = 0.022).</div></div><div><h3>Conclusions</h3><div>This meta-analysis suggests that VL may improve first-attempt success and glottic visualization and may reduce complications compared with DL in infants and neonates. Intubation times appear similar between the two approaches. However, moderate heterogeneity, variability in VL devices, and potential operator dependence indicate that these findings should be interpreted with caution. Further clinical trials are warranted to validate these results and explore the long-term implications of VL on patient outcomes.</div></div>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"107 \",\"pages\":\"Article 112024\"},\"PeriodicalIF\":5.1000,\"publicationDate\":\"2025-09-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0952818025002855\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818025002855","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景：婴儿和新生儿的气管插管是一项关键但具有挑战性的手术，时间窗很窄。本荟萃分析旨在比较视频喉镜（VL）与直接喉镜（DL）在首次尝试成功率、插管时间和并发症发生率方面的差异。方法检索PubMed、Cochrane和Embase数据库，对截至2024年6月发表的随机对照试验（rct）进行系统回顾和荟萃分析，比较1岁以下婴儿和新生儿（0-28天）的VL和DL。主要结局包括首次尝试成功率，次要结局包括插管时间（TTI）和并发症发生率。对新生儿进行亚组分析。结果在我们对17项随机对照试验的分析中，1918名参与者，VL的首次尝试成功率高于DL (87.5% vs 78%; OR 2.13; p < 0.001)，新生儿的结果相似（77.6% vs 63%; OR 2.12; p = 0.027）。VL也改善了到达最佳视角的时间（MD -2.85; p < 0.01）， POGO评分显著提高（MD 16.8; p < 0.01）。然而，在缩短插管时间方面，VL比DL没有优势（MD 0.79; p = 0.49）。与DL相比，VL减少了并发症（2.77% vs 8.44%; OR 0.33; p = 0.022）。结论本荟萃分析表明，与DL相比，VL可提高婴儿和新生儿的首次尝试成功率和声门显像，并可减少并发症。两种方法的插管时间相似。然而，中度异质性、VL装置的可变性和潜在的操作者依赖性表明，这些发现应该谨慎解释。需要进一步的临床试验来验证这些结果，并探索VL对患者预后的长期影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Video laryngoscopy vs. direct laryngoscopy in infants and neonates: A systematic review and meta-analysis

Background

Endotracheal intubation in infants and neonates is a critical yet challenging procedure with a narrow time window. This meta-analysis aimed to compare video laryngoscopy (VL) to direct laryngoscopy (DL) regarding first-attempt success, time to intubation, and complication rates.

Methods

We searched PubMed, Cochrane, and Embase databases and conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published up to June 2024, comparing VL and DL in infants less than one-year-old and neonates (defined as infants 0–28 days old). Primary outcomes included first-attempt success rate, while secondary outcomes were time to intubation (TTI) and complication rates. A subgroup analysis was performed for neonates.

Results

In our analysis of 17 RCTs with 1918 participants, VL demonstrated a higher first-attempt success rate compared to DL (87.5 % vs 78 %; OR 2.13; p < 0.001), with similar results in neonates (77.6 % vs 63 %; OR 2.12; p = 0.027). VL also improved the time to best view (MD -2.85; p < 0.01) and showed significantly better POGO scores (MD 16.8; p < 0.01). However, there was no advantage of VL over DL in reducing time to intubation (MD 0.79; p = 0.49). VL reduced complications compared to DL (2.77 % vs 8.44 %; OR 0.33; p = 0.022).

Conclusions

This meta-analysis suggests that VL may improve first-attempt success and glottic visualization and may reduce complications compared with DL in infants and neonates. Intubation times appear similar between the two approaches. However, moderate heterogeneity, variability in VL devices, and potential operator dependence indicate that these findings should be interpreted with caution. Further clinical trials are warranted to validate these results and explore the long-term implications of VL on patient outcomes.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.