Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis
<b>Purpose:</b> Hemodynamic response, particularly increased heart rate (HR) and blood pressure, can occur during tracheal intubation and is an adverse event to be avoided. The aim of this study was to use a network meta-analysis (NMA) to develop a ranking of hemodynamic responses (HR an...
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MDPI AG
2025-06-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/12/6/786 |
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| author | Risa Takeuchi Hiroshi Hoshijima Masanori Tsukamoto Shinichi Kokubu Takahiro Mihara Toshiya Shiga |
| author_facet | Risa Takeuchi Hiroshi Hoshijima Masanori Tsukamoto Shinichi Kokubu Takahiro Mihara Toshiya Shiga |
| author_sort | Risa Takeuchi |
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| description | <b>Purpose:</b> Hemodynamic response, particularly increased heart rate (HR) and blood pressure, can occur during tracheal intubation and is an adverse event to be avoided. The aim of this study was to use a network meta-analysis (NMA) to develop a ranking of hemodynamic responses (HR and mean blood pressure, MBP) after intubation of indirect and direct laryngoscopes in pediatric patients. <b>Method:</b> Studies were eligible for inclusion if they had a prospective randomized design, compared hemodynamic response (HR and MBP) to tracheal intubation between indirect and/or direct laryngoscopes, and were conducted in pediatric patients. The pooled difference between each intubation device’s intubation time is expressed as a weighted mean difference (WMD) of a 95% confidence interval (CI). The intubation time of the device was evaluated using P-scores calculated from the network point estimates and standard errors. A random-effects model was used when pooling effect sizes. We also analyzed intubation time as a related factor to hemodynamic responses. <b>Results:</b> From the electronic databases, we selected 16 trials for review. In a Macintosh-referenced analysis, Airtraq suppressed an increase of HR and MBP during tracheal intubation in pediatric patients significantly more than a Macintosh laryngoscope. (HR; WMD = −16.7, 95%CI −22.5 to −10.9, MBP; WMD = −8.57, 95%CI −10.9 to −6.27). Airtraq also topped the HR and MBP P-score rankings. The results of this study showed similar laryngoscopes in the top five rankings of P-scores (Airtraq, Coopdech video laryngoscope, Miller, C-MAC, Wis-Hipple) for HR and intubation time. <b>Conclusions:</b> We applied a network meta-analysis to create a consistent ranking of intubation devices that prevent hemodynamic changes during tracheal intubation in pediatric patients. In this NMA, Airtraq proved to be the best laryngoscope for preventing hemodynamic responses during tracheal intubation in pediatric patients. In the analysis of intubation time, Airtraq showed the shortest intubation time. |
| format | Article |
| id | doaj-art-81876978dc154d978efd82afa646c100 |
| institution | Kabale University |
| issn | 2227-9067 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj-art-81876978dc154d978efd82afa646c1002025-08-20T03:26:21ZengMDPI AGChildren2227-90672025-06-0112678610.3390/children12060786Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-AnalysisRisa Takeuchi0Hiroshi Hoshijima1Masanori Tsukamoto2Shinichi Kokubu3Takahiro Mihara4Toshiya Shiga5Bunkoukai Special Needs Dental Clinic, 2765-5 Ujiie, Sakura 329-1311, JapanDivision of Dento-Oral Anesthesiology, Graduate School of Dentistry, Tohoku University, 4-1 Seiryomachi, Sendai 980-8575, JapanSystemic Management for Dentistry, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima 890-0075, JapanDepartment of Anesthesiology, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, JapanDepartment of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama 236-0004, JapanDepartment of Anesthesiology and Pain Medicine, International University of Health and Welfare Ichikawa Hospital, 6-1-4 Kounodai, Ichikawa 272-0827, Japan<b>Purpose:</b> Hemodynamic response, particularly increased heart rate (HR) and blood pressure, can occur during tracheal intubation and is an adverse event to be avoided. The aim of this study was to use a network meta-analysis (NMA) to develop a ranking of hemodynamic responses (HR and mean blood pressure, MBP) after intubation of indirect and direct laryngoscopes in pediatric patients. <b>Method:</b> Studies were eligible for inclusion if they had a prospective randomized design, compared hemodynamic response (HR and MBP) to tracheal intubation between indirect and/or direct laryngoscopes, and were conducted in pediatric patients. The pooled difference between each intubation device’s intubation time is expressed as a weighted mean difference (WMD) of a 95% confidence interval (CI). The intubation time of the device was evaluated using P-scores calculated from the network point estimates and standard errors. A random-effects model was used when pooling effect sizes. We also analyzed intubation time as a related factor to hemodynamic responses. <b>Results:</b> From the electronic databases, we selected 16 trials for review. In a Macintosh-referenced analysis, Airtraq suppressed an increase of HR and MBP during tracheal intubation in pediatric patients significantly more than a Macintosh laryngoscope. (HR; WMD = −16.7, 95%CI −22.5 to −10.9, MBP; WMD = −8.57, 95%CI −10.9 to −6.27). Airtraq also topped the HR and MBP P-score rankings. The results of this study showed similar laryngoscopes in the top five rankings of P-scores (Airtraq, Coopdech video laryngoscope, Miller, C-MAC, Wis-Hipple) for HR and intubation time. <b>Conclusions:</b> We applied a network meta-analysis to create a consistent ranking of intubation devices that prevent hemodynamic changes during tracheal intubation in pediatric patients. In this NMA, Airtraq proved to be the best laryngoscope for preventing hemodynamic responses during tracheal intubation in pediatric patients. In the analysis of intubation time, Airtraq showed the shortest intubation time.https://www.mdpi.com/2227-9067/12/6/786indirect laryngoscopehemodynamic responsespediatricnetwork meta-analysis |
| spellingShingle | Risa Takeuchi Hiroshi Hoshijima Masanori Tsukamoto Shinichi Kokubu Takahiro Mihara Toshiya Shiga Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis Children indirect laryngoscope hemodynamic responses pediatric network meta-analysis |
| title | Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis |
| title_full | Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis |
| title_fullStr | Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis |
| title_full_unstemmed | Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis |
| title_short | Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis |
| title_sort | hemodynamic response to tracheal intubation using indirect and direct laryngoscopes in pediatric patients a systematic review and network meta analysis |
| topic | indirect laryngoscope hemodynamic responses pediatric network meta-analysis |
| url | https://www.mdpi.com/2227-9067/12/6/786 |
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