Indirect laryngoscopy is more effective than direct laryngoscopy when tracheal intubation is performed by novice operators: a systematic review, meta-analysis, and trial sequential analysis
Pooled result · Tracheal intubation success rateResult — go to the resultRR for successful intubation 1.15 95% CI 1.07–1.24Authors' conclusion
In this systematic review, we found that the tracheal intubation success rate, glottic visualization, and intubation time were improved when novice operators used indirect laryngoscopy rather than direct laryngoscopy.
Study context
- Population
- Adults intubated by novice operators15 articles (17 trials)
- Participants
- 2,290 adults
- Comparison
- Indirect laryngoscopy vs Direct laryngoscopy
- Outcome
- Tracheal intubation success rate, glottic visualization and intubation time
Methodological detailsrandom-effects model, trial sequential analysis
- Random-effects model
- Trial sequential analysis
Pooled result
Tracheal intubation success rate
RR for successful intubation
1.15
95% CI 1.07–1.24
P = 0.0002
Indirect laryngoscopy vs Direct laryngoscopy
RR for successful intubation 1.15 (95% CI 1.07–1.24); P = 0.0002
As reported in the abstract
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Glottic visualizationI2 = 85% | 1.76 (1.36–2.28) | P < 0.001 | |
| 0.512Relative risk (log scale) |
| Outcome | WMD (sec) (95% CI) | P value | |
|---|---|---|---|
| Intubation timeI2 = 98% · Trial sequential analysis: sample size sufficient | −9.06 (−16.4 to −1.76) | P = 0.01 | |
| −20−10010Difference, sec (linear scale) |
Original publication
Indirect laryngoscopy is more effective than direct laryngoscopy when tracheal intubation is performed by novice operators: a systematic review, meta-analysis, and trial sequential analysis. Can J Anaesth. Published 21 November 2023. doi:10.
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