Evidence map›Paper›PMID 41046172›Full record

SynthesisBritish journal of anaesthesia2025

Videolaryngoscopy versus direct laryngoscopy for paediatric tracheal intubation: a systematic review with meta-analysis and trial sequential analysis.

Gabriela Koepp-Medina, Andrea C Lusardi, Benedetta Di Fonzo, Markus Huber, Arash Afshari, Rachele Bonfiglio, Lea Zimmermann, Vera Bohnenblust, Robert Greif, Janne Vendt and 3 more

Registry-linked trialAbstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in British journal of anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07495436 (Videolaryngoscopy Versus Direct Laryngoscopy for Tracheal Intubation in Pediatric Surgery), which is not on this map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07495436 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Videolaryngoscopy Versus Direct Laryngoscopy for Tracheal Intubation in Pediatric Surgery: The VIDEOKIDS Pragmatic Multicentre Randomized Trial

TypeinterventionalSponsorHospital Clinico Universitario de SantiagoRan2026 to 2027Enrolled5,562ConditionsTracheal Intubation, Videolaryngoscopy, General Anesthesia, Difficult Airway IntubationArmsVideolaryngoscope, Direct Laryngoscope
3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
  2. Article
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Gabriela Koepp-MedinaDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: gmedinav2016@gmail.com.
Andrea C LusardiUnit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Benedetta Di FonzoUnit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Markus HuberDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Arash AfshariDepartment of Paediatric and Obstetric Anaesthesia, Juliane Marie Centre, Rigshospitalet & Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Rachele BonfiglioUnit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Lea ZimmermannDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Vera BohnenblustDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Robert GreifDepartment of Surgical Science, University of Turin, Turin, Italy; Faculty of Medicine, University of Bern, Bern, Switzerland.
Janne VendtMedical Library Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Thomas RivaDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Nicola DismaUnit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Alexander FuchsDepartment of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPaediatric tracheal intubation presents unique challenges owing to anatomical and physiological characteristics. Multiple intubation attempts increase the risk of severe complications; therefore, achieving high first-pass success is critical. Videolaryngoscopy (VL) represents an alternative to direct laryngoscopy (DL), but its comparative efficacy, safety, and clinical impact in paediatric practice remain under investigation.

methodsThis systematic review and meta-analysis evaluated VL vs DL for paediatric tracheal intubation, focusing on first-attempt success rate, glottic visualisation, intubation time, and critical events. Eight databases were searched. RCTs comparing VL and DL in paediatric patients (<16 yr) were included.

resultsOf 22 221 screened articles, 53 RCTs (4887 patients) met inclusion criteria. VL and DL showed comparable first-attempt tracheal intubation success rates, without a statistically significant difference (risk ratio: 1.03, 95% confidence interval [95% CI]: 0.99-1.07, P=0.18). Certainty of evidence was rated as high by the Grading of Recommendations Assessment, Development, and Evaluation criteria. Intubation time was slightly longer with VL (mean difference: +3 s, 95% CI: 0.1-5.4). VL improved glottic visualisation across all paediatric age groups (Percentage of Glottic Opening score, mean difference: 9.8%, 95% CI: 3.2-16.4, P<0.01) and reduced oesophageal intubation in children under 1 yr of age (risk ratio: 0.16, 95% CI: 0.06-0.40, P<0.01).

conclusionsIn paediatric patients with mostly normal airways, no significant differences were observed between VL and DL in achieving first-attempt tracheal intubation success. VL improved glottic visualisation, and, in patients under 1 yr of age, reduced oesophageal intubation with low certainty of evidence. Trial sequential analysis indicates that the available data remain underpowered to confirm a definitive effect. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42024498524).

Indexed as

Intubation, IntratrachealLaryngoscopyVideo-Assisted Techniques and ProceduresAdolescentChildChild, PreschoolHumansInfantRandomized Controlled Trials as Topicairwaydirect laryngoscopyintubationpaediatric anaesthesiavideolaryngoscopy

Identifiers

PMID41046172
PMCPMC12597347

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.