Articles

Video Laryngoscopy Versus Direct Laryngoscopy in Novices: A Randomized Clinical Trial

Abstract

Intubating the trachea is a challenging task, especially for novice intubators. Successful intubation, in the shortest possible time, prevents hypoxia and hemodynamic disturbances. During the last few decades, video laryngoscopy has proven to be a helpful tool for intubating patients successfully, especially in difficult cases. However, novices must be proficient with a video laryngoscopy. It is not entirely clear which method, direct laryngoscopy or video laryngoscopy, is more successful for tracheal intubation in individuals who have recently started their airway management training. In this study, we aim to investigate this issue. 150 patients were randomly assigned to either direct laryngoscopy or video laryngoscopy by first-year anesthesia assistants. Intubation time, intubation success rate, Cormack-Lehane score, and instances of using the Optimal external laryngeal manipulation (OELM) maneuver, were recorded. The rate of successful intubation was higher in the direct laryngoscopy group, and the time taken was less. The direct laryngoscopy provided a better view of the glottis than the video laryngoscopy, although this difference was not statistically significant. Direct laryngoscopy resulted in a higher frequency of OELM. Based on our study, the success rate and speed of intubation in novices were higher with direct laryngoscopy compared to video laryngoscopy.

1. Alvarado AC, Panakos P. Endotracheal Tube Intubation Techniques. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
2. Panda N, Donahue DM. Acute airway management. Ann Cardiothorac Surg 2018;7:266-72.
3. Vaida S, Gaitini L, Somri M, Matter I, Prozesky J. Airway Management During the Last 100 Years. Crit Care Clin 2023;39:451-64.
4. Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: a Cochrane systematic review and meta-analysis update. Br J Anaesth 2022;129:612-23.
5. Wong J, Lee JSE, Wong TGL, Iqbal R, Wong P. Fibreoptic intubation in airway management: a review article. Singapore Med J 2019;60:110-8.
6. Prekker ME, Driver BE, Trent SA, Resnick-Ault D, Seitz KP, Russell DW, et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med 2023;389:418-29.
7. Pourmand A, Terrebonne E, Gerber S, Shipley J, Tran QK. Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis. Prehosp Disaster Med 2022:1-11.
8. MacKinnon J, McCoy C. Use of video laryngoscopy versus direct laryngoscopy as a teaching tool for neonatal intubation: A systematic review. Can J Respir Ther 2023;59:111-6.
9. Zeidan A, Quintard H, Myatra S, El-Tahan M. Direct versus video-laryngoscopy: A game-changer for tracheal intubation in critically ill adult patients. Anaesth Crit Care Pain Med 2023;43:101316.
10. Russell DW, Casey JD, Gibbs KW, Ghamande S, Dargin JM, Vonderhaar DJ, et al. Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA 2022;328:270-9.
11. Loughnan A, Deng C, Dominick F, Pencheva L, Campbell D. A single-centre, randomised controlled feasibility pilot trial comparing performance of direct laryngoscopy versus videolaryngoscopy for endotracheal intubation in surgical patients. Pilot Feasibility Stud 2019;5:50.
12. Bakshi SG, Vanjari VS, Divatia JV. A prospective, randomised, clinical study to compare the use of McGrath(®), Truview(®) and Macintosh laryngoscopes for endotracheal intubation by novice and experienced Anaesthesiologists. Indian J Anaesth 2015;59:421-7.
13. Peirovifar A, Mahmoodpoor A, Golzari SE, Soleimanpour H, Eslampour Y, Fattahi V. Efficacy of video-guided laryngoscope in airway management skills of medical students. J Anaesthesiol Clin Pharmacol 2014;30:488-91.
14. Abdelgadir IS, Phillips RS, Singh D, Moncreiff MP, Lumsden JL. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates). Cochrane Database Syst Rev 2017;5:CD011413.
15. van Schuppen H, Wojciechowicz K, Hollmann MW, Preckel B. Tracheal Intubation during Advanced Life Support Using Direct Laryngoscopy versus Glidescope® Videolaryngoscopy by Clinicians with Limited Intubation Experience: A Systematic Review and Meta-Analysis. J Clin Med 2022;11:6291.
16. Di Marco P, Scattoni L, Spinoglio A, Luzi M, Canneti A, Pietropaoli P, et al. Learning curves of the Airtraq and the Macintosh laryngoscopes for tracheal intubation by novice laryngoscopists: a clinical study. Anesth Analg 2011;112:122-5.
17. Nalubola S, Jin E, Drugge ED, Weber G, Abramowicz AE. Video Versus Direct Laryngoscopy in Novice Intubators: A Systematic Review and Meta-Analysis. Cureus 2022;14:e29578.
18. Carron M, Ieppariello G, Linassi F. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in obese adults: A meta-analysis. J Clin Anesth 2021;71:110216.
19. Risse J, Volberg C, Kratz T, Plöger B, Jerrentrup A, Pabst D, et al. Comparison of videolaryngoscopy and direct laryngoscopy by German paramedics during out-of-hospital cardiopulmonary resuscitation; an observational prospective study. BMC Emerg Med 2020;20:22.
20. Janz DR, Semler MW, Lentz RJ, Matthews DT, Assad TR, Norman BC, et al. Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults. Crit Care Med 2016;44:1980-7.
21. Liu ZJ, Yi J, Guo WJ, Ma C, Huang YG. Comparison of McGrath Series 3 and Macintosh Laryngoscopes for Tracheal Intubation in Patients with Normal Airway by Inexperienced Anesthetists: A Randomized Study. Medicine (Baltimore) 2016;95:e2514.
22. Lye ST, Liaw CM, Seet E, Koh KF. Comparison of results from novice and trained personnel using the Macintosh laryngoscope, Pentax AWS®, C-MAC™ and Bonfils intubation fibrescope: a manikin study. Singapore Med J 2013;54:64-8.
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IssueVol 61 No 9 (2023) QRcode
SectionArticles
DOI https://doi.org/10.18502/acta.v61i9.15283
Keywords
Tracheal intubation Direct laryngoscopy Video laryngoscopy Airway management Novice intubators Anesthesia assistants

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1.
Effatdoos R, Eslami B, Nabavian O, Maghsoudloo M, Pestei K, Samadi S, Dehghan Tazerjani M. Video Laryngoscopy Versus Direct Laryngoscopy in Novices: A Randomized Clinical Trial. Acta Med Iran. 2024;61(9):526-530.