Comparison of videolaryngoscope & direct laryngoscope for intubation in critically ill patients: A Bayesian meta-analysis

Purpose: To identify the benefit of video laryngoscope (VL) over direct laryngoscope (DL) for intubation in the intensive care unit (ICU) Material & Methods: Randomized controlled trials (RCTs) comparing VL with DL for intubation in ICU by was conducted in conventional frequentist methodology and also incorporated of the previous evidences from observational studies in Bayesian methodology. Results: Data of 1464 patients from six RCTs have been included in this meta-analysis. In conventional meta-analysis of RCTs, first attempt intubation success rate was similar between VL and DL group [p=0.39]. Rate of esophageal intubation was significantly less with VL [p=0.03] and glottic visualization was significantly improved with VL in comparison to DL [p=0.009]. Time to intubation was similar in both the group [p=0.48]. When evidences from a meta-analysis of observational studies incorporated in Bayesian model, first attempt intubation success is significantly higher with VL [posterior median log OR (95% credible interval) 0.50 (0.06, 1.00)]. Conclusion: Evidences from both observational studies and RCTs synthesized in Bayesian methodology suggest that use of VL for endotracheal intubation in critically patients may be associated with higher first intubation success when compared to DL.