Comparative Outcomes of Video vs. Direct Laryngoscopy in Adults in Critical Condition: A Narrative Review of First-Attempt Success, Complications, and Contextual Decision-Making
Resultados comparativos de la video laringoscopia frente a la laringoscopia directa en adultos en estado crítico: Una revisión narrativa del éxito en el primer intento, complicaciones y toma de decisiones contextual
Cristian Camilo Villa Gómez, Camilo Hernández Ortiz, Julio Andrés Boda Garnica, Omar Andrés Olea Muñoz, Daniela Giraldo Restrepo, Angie Marcela Pérez Pinto, Marlon Andrés David Orrego, Luisa Fernanda Herrera Aguirre, Gustavo Adolfo Serrano Baez
Abstract
Tracheal intubation emerges as a fundamental medical procedure for critically ill patients, facilitating the establishment of a secure airway and ensuring adequate oxygenation and ventilation. This narrative review compares video laryngoscopy (VL) and direct laryngoscopy (DL) in critically ill adults, evaluating three key parameters: first-attempt success rates, incidence of severe complications (hypoxemia, hemodynamic instability), and contextual factors influencing technique selection (patient anatomy, operator expertise, resource availability). Literature review found that challenges frequently arise in critically ill patients, influencing their respiratory, cardiovascular, and neurological systems. The primary techniques for tracheal intubation include DL and VL. Various studies have compared these techniques across diverse clinical scenarios. While some studies suggest potential advantages of VL, such as higher first-attempt success rates, others report no significant disparities. These findings underscore the inherent complexities in decision-making. To make an informed choice, considerations must include patient anatomy, operator experience, equipment availability, continuous monitoring, and adherence to clinical guidelines. Thus, the determination between DL and VL for intubating critically ill patients is multifaceted. Individual patient assessment, clinician proficiency, and resource accessibility are of paramount importance. Adherence to best practices and the ability to dynamically adapt to unforeseen challenges are critical aspects. Patient safety remains the highest priority, and these strategies provide a comprehensive framework for informed decision-making in critical scenarios. Ongoing research and continuous evaluation of clinical guidelines are essential endeavors to enhance our understanding of the most suitable technique for specific circumstances.
Keywords
Resumen
La intubación traqueal emerge como un procedimiento médico fundamental para pacientes en condición crítica, facilitando el establecimiento de una vía aérea segura y asegurando una adecuada oxigenación y ventilación. Esta revisión compara la video laringoscopia (VL) y la laringoscopia directa (DL) en adultos en estado crítico, evaluando tres parámetros clave: éxito en el primer intento, incidencia de complicaciones graves (hipoxemia, inestabilidad hemodinámica) y factores contextuales que influyen en la elección de la técnica (anatomía del paciente, experiencia del operador, disponibilidad de recursos). Después de la revisión de la literatura, se encontró que los desafíos se manifiestan con frecuencia en pacientes críticamente enfermos, afectando sus sistemas respiratorio, cardiovascular y neurológico. Las técnicas utilizadas principalmente para la intubación traqueal incluyen DL y VL. Diversos estudios han comparado estas técnicas en diversos escenarios clínicos. Mientras que algunos estudios sugieren posibles ventajas de la VL, como tasas de éxito elevadas en el primer intento, otros informan de ninguna disparidad significativa. Estos hallazgos subrayan las complejidades inherentes en la toma de decisiones. Para llegar a una elección informada, se deben considerar la anatomía del paciente, la experiencia del operador, la disponibilidad de equipos, el monitoreo continuo y la adherencia a las pautas clínicas. Entonces, la determinación entre DL y VL para la intubación de pacientes críticamente enfermos es multifacética. La evaluación individual del paciente, la habilidad del profesional y la disponibilidad de recursos son de importancia crucial. La adherencia a las mejores prácticas y la capacidad para adaptarse dinámicamente a desafíos imprevistos surgen como aspectos primordiales. La seguridad del paciente sigue siendo la máxima prioridad, y estas estrategias proporcionan un marco integral para la toma de decisiones informada en escenarios críticos. La investigación continua y la evaluación constante de las pautas clínicas son esfuerzos esenciales para mejorar nuestra comprensión de la técnica más adecuada para circunstancias específicas.
Palabras clave
References
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Submitted date:
10/09/2024
Reviewed date:
03/18/2025
Accepted date:
04/30/2025
Publication date:
05/13/2025
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