Ranking videolaryngoscopes by orotracheal intubation performance: protocol of a systematic review and network meta-analysis of clinical trials at patient level.

Background: Videolaryngoscopes (VLs) are regarded to improve glottic visualization as compared to Macintosh laryngoscope (ML). However, we currently do not know which one would be the best choice. We then designed this systematic review and network meta-analysis to rank the different VLs as compared to ML. Methods: We will conduct a search in PubMed, LILACS, Scielo, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 6) on 11/01/2021. We will include randomized clinical trials fully reported with patients aged ≥ 16 years, comparing VLs with ML for failed intubation with the device, failed first intubation attempts, number of intubation attempts, time for intubation, difficulty of intubation, and improved visualization of the larynx. Pooled effects will be estimated by both fixed and random-effects models and presented according to qualitative and quantitative heterogeneity assessment. Sensitivity analyses will be performed as well as a priori subgroup, meta-regression and multiple meta-regression analyses. Additionally, network meta-analyses will be applied to rank the different VLs as compared to ML. We will also assess the risk of selective publication by funnel plot asymmetry. Discussion: This systematic review and network meta-analysis aim at helping health services and clinicians involved in airway manipulation choose the best VLs for orotracheal intubation. Systematic review registration: The current protocol was submitted to PROSPERO on 07/01/2021.