Videolaryngoscopy versus fiberoptic bronchoscopy for awake tracheal intubation. Systematic review and meta-analysis

Introduction: All of the international guidelines and consensus documents recommend managing the difficult airway while maintaining spontaneous breathing during tracheal intubation. Currently, the safest and most widely used techniques are flexible bronchoscopy and videolaryngoscopy. Objective: The aim of this systematic review and meta-analysis was to compare videolaryngoscopy (VL) versus fiberoptic bronchoscopy (FB) for ATI (ATI). Methods: A systematic search of randomized clinical trials was conducted in PubMed, Web of Science and CENTRAL, following the PRISMA guidelines. The Cochrane RoB2 tool was used to analyze risk of bias. A random effects model was used and heterogeneity was quantified by means of the I2 test. Results: Of 1,254 entries retrieved, 11 met the inclusion criteria for review and 10 were included in the meta-analysis (593 patients). There were no significant differences between the two intubation techniques on first attempt (9 studies, 576 patients, risk ratio [RR] [95% CI] 1.00 [0.95-1.06]), or in terms of intubation success (9 studies, 539 patients, RR [95% CI] 0.99 [0.97-1.02]). VL was associated with shorter intubation time (10 studies, 580 patients, mean [95% CI] -50.39 [-82.0–18.8] seconds) and a lower incidence of hypoxia (7 studies, 461 patients, RR [IC95 %] 0.48 [0.24-0.98]). There were no differences regarding the incidence of other complications. Conclusions: VL and FB for awake intubation are equally effective in terms of intubation on first attempt and overall success of the technique. VL was associated with a shorter intubation time and a lower incidence of hypoxia.