Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates

Lingappan, Krithika; Neveln, Nicole; Arnold, Jennifer L; Fernandes, Caraciolo J; Pammi, Mohan

doi:10.1002/14651858.cd009975.pub4

Cited by 9 publications

(5 citation statements)

References 43 publications

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“…The second section may suggest that the video laryngoscope sometimes required more adjustments to maintain a proper vision of the vocal cords and more time to insert the tube. While the longer time for tube insertion has already been reported in literature [ 10 , 11 ], we can speculate that the participants were more familiar with the direct laryngoscope, despite having a sufficient experience with both devices. The third section may suggest that the participants prolonged the visualization of the glottis on the screen while removing the blade of the video laryngoscope.…”

Section: Discussionmentioning

confidence: 70%

Neonatal intubation: what are we doing?

Maglio,

Cavallin,

Sala

et al. 2024

Eur J Pediatr

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How and when the forces are applied during neonatal intubation are currently unknown. This study investigated the pattern of the applied forces by using sensorized laryngoscopes during the intubation process in a neonatal manikin. Nine users of direct laryngoscope and nine users of straight-blade video laryngoscope were included in a neonatal manikin study. During each procedure, relevant forces were measured using a force epiglottis sensor that was placed on the distal surface of the blade. The pattern of the applied forces could be divided into three sections. With the direct laryngoscope, the first section showed either a quick rise of the force or a discontinuous rise with several peaks; after reaching the maximum force, there was a sort of plateau followed by a quick drop of the applied forces. With the video laryngoscope, the first section showed a quick rise of the force; after reaching the maximum force, there was an irregular and heterogeneous plateau, followed by heterogeneous decreases of the applied forces. Moreover, less forces were recorded when using the video laryngoscope. Conclusions: This neonatal manikin study identified three sections in the diagram of the forces applied during intubation, which likely mirrored the three main phases of intubation. Overall, the pattern of each section showed some differences in relation to the laryngoscope (direct or video) that was used during the procedure. These findings may provide useful insights for improving the understanding of the procedure. What is Known:• Neonatal intubation is a life-saving procedure that requires a skilled operator and may cause direct trauma to the tissues and precipitate adverse reactions.• Intubation with a videolaryngoscope requires less force than with a direct laryngoscope, but how and when the forces are applied during the whole neonatal intubation procedure are currently unknown. What is New:• Forces applied to the epiglottis during intubation can be divided into three sections: (i) an initial increase, (ii) a sort of plateau, and (iii) a decrease.• The pattern of each section shows some differences in relation to the laryngoscope (direct or videolaryngoscope) that is used during the procedure.

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Section: Discussionmentioning

confidence: 70%

Neonatal intubation: what are we doing?

Maglio,

Cavallin,

Sala

et al. 2024

Eur J Pediatr

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“…It was specifically developed for tracheal intubation using a gum elastic bougie and employing the paraglossal technique. Several studies have affirmed the effectiveness of the VieScope laryngoscope in improving the success rate of endotracheal intubation [85][86][87][88][89][90][91].…”

Section: Three-dimensional Technologymentioning

confidence: 99%

New Devices, Innovative Technologies, and Non-Standard Techniques for Airway Management: A Narrative Review

Gaszyński,

Gómez-Ríos,

Serrano-Moraza

et al. 2023

Healthcare

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A wide range of airway devices and techniques have been created to enhance the safety of airway management. However, airway management remains a challenge. All techniques are susceptible to failure. Therefore, it is necessary to have and know the greatest number of alternatives to treat even the most challenging airway successfully. The aim of this narrative review is to describe some new devices, such as video laryngeal masks, articulated stylets, and non-standard techniques, for laryngeal mask insertion and endotracheal intubation that are not applied in daily practice, but that could be highly effective in overcoming a difficulty related to airway management. Artificial intelligence and 3D technology for airway management are also discussed.

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“…The high incidence of adverse events has led to the development of various strategies to enhance safety during neonatal intubation. These include the use of individualized airway bundles ( 5 ), premedication ( 6 ), stylets ( 7 , 8 ), high-flow nasal cannula oxygen supplementation during intubation attempts ( 3 ), simulation training ( 9 ), and video laryngoscopy ( 10 ). The latter has been the subject of intense debate, considering the fact that direct laryngoscopy has been the primary approach for neonatal intubation for decades.…”

mentioning

confidence: 99%

“…Tracheal intubation of anesthetized infants in the operating room using video laryngoscopy has been shown to result in a significantly higher first-attempt success rate compared to direct laryngoscopy [93% vs. 88%; adjusted absolute risk difference 5.5%; 95% confidence interval (CI): 0.7% to 10.3%; P=0.024], and a significantly lower rate of severe complications (2% vs. 5.5%; adjusted absolute risk difference −3.7%; 95% CI: −6.5% to −0.9%; P=0.0087) ( 11 ). A Cochrane systematic review and meta-analysis published in 2023 comprising eight studies that evaluated 759 intubation attempts in neonates concluded that video laryngoscopy was associated with a higher first-attempt success rate, the need for fewer intubation attempts, and less airway trauma compared to direct laryngoscopy ( 10 ). Another important variable known to influence first-attempt success in small infants is the provision of high-flow oxygen therapy (also called apneic oxygenation when neuromuscular blockade is administered) during the intubation procedure.…”

mentioning

confidence: 99%

“…In light of the evident advantage of video laryngoscopy demonstrated by Rivas and colleagues ( 1 ), and others ( 10 , 11 , 13 ) under controlled non-emergent conditions, some practitioners may question the potential extension of these benefits beyond the operating room. Observational studies conducted outside the NICU setting, such as those including both neonates and older children in the pediatric intensive care unit (PICU) have reported benefits associated with the use of video laryngoscopy ( 14 ).…”

mentioning

confidence: 99%

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Video laryngoscopy as the standard of care for pediatric intubation—the time is now

Miller,

Mallory,

Rotta

2024

Transl Pediatr

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Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates

Cited by 9 publications

References 43 publications

Neonatal intubation: what are we doing?

Neonatal intubation: what are we doing?

New Devices, Innovative Technologies, and Non-Standard Techniques for Airway Management: A Narrative Review

Video laryngoscopy as the standard of care for pediatric intubation—the time is now

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