Dear Editor,
We read with great interest the article by Pascarella et al. outlining the efficacy and safety of the VL3 videolaryngoscope for tracheal intubation in 56 adult surgical patients. The authors describe a 92.9% Cormack–Lehane (CL) grade I glottis view and 85.7% first-attempt intubation success rate with VL3 and, recommend the device for routine practice to mitigate the anticipated and unanticipated airway difficulties.[1]
Despite the commendable effort of the research group and noteworthy inclusions such as predicted difficult airway scoring (El Ganzouri Total Risk Index), the clinical value of the preliminary results is limited by the lack of a control group. Interestingly, the absence becomes even more remarkable? considering the fact that a panoramic view of videolaryngoscopic airway management literature fails to provide conclusive evidence to suggest an improved routine first-attempt intubation success rate and time to intubation albeit an improved glottis visualization compared to direct laryngoscopy. The 2016 Cochrane database and the 2018 systematic review of the available literature bear testimony to the aforementioned statement while many independent researchers also demonstrate a prolonged intubation time with videolaryngoscopes given the need for a sound visuospatial orientation in such scenarios.[2,3,4] In addition, a larger number of patients with continuous comparative data presentation could have added merit to this study involving an experienced anesthesiologist.
On one hand, where the application of videolaryngoscopes is distinct in difficult airways owing to an improved glottis visualization, the official routine recommendations (as proposed by the authors) can only be premised on robust and prudent head-on comparisons in this era of evidence-based medicine due to the peculiar challenges in developing intubation guidelines that are aphoristic given the diversity of the clinical settings (necessitating tracheal intubation) and the available airway equipments.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.Pascarella G, Caruso S, Antinolfi V, Costa F, Sarubbi D, Agrò FE. The VL3 videolaryngoscope for tracheal intubation in adults: A prospective pilot study. Saudi J Anaesth. 2020;14:318–22. doi: 10.4103/sja.SJA_145_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev. 2016;11:CD011136. doi: 10.1002/14651858.CD011136.pub2. doi: 10.1002/14651858.CD011136.pub2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Arulkumaran N, Lowe J, Ions R, Mendoza M, Bennett V, Dunser MW. Videolaryngoscopy versus direct laryngoscopy for emergency orotracheal intubation outside the operating room: A systematic review and meta-analysis. Br J Anaesth. 2018;120:712–24. doi: 10.1016/j.bja.2017.12.041. [DOI] [PubMed] [Google Scholar]
- 4.Hung O. Can't see for looking: Tracheal intubation using video laryngoscopes. Can J Anesth. 2020;67:505–10. doi: 10.1007/s12630-020-01585-9. [DOI] [PubMed] [Google Scholar]