Videolaryngoscopy: a good substitute of Direct Laryngoscopy?

Abstract

Direct laryngoscopy (DL) is the gold standard technique for advanced airway management. However, currently, the most evolved devices for are Video Laryngoscopes (VL), which allow an Indirect Laryngoscopy and are already used in different clinical contexts. Some questions remain unclear concerning VL advantages over DL. This article aims to discuss if VL can be a good substitution for DL in the future. To write this review, relevant articles were identified via MEDLINE search, followed by a secondary search of references cited by retrieved articles. Search engines, indexing services and repositories were also utilized to trace documents as far back as 2000. In difficult airway, VL was associated with an easier intubation and a shorter intubation time. It can also be useful in trauma victims with cervical spine immobilization, emergency situations and morbidly obese patients. VL showed superiority as a learning tool and when the patient is not in supine position. However, VL has also some limitations such as loss of depth perception, soft tissues injury, a false sense of security and some economical issues. Data regarding hemodynamic response is conflicting. Thus, more studies with big samples are needed to figure out if VL is safer than DL, namely in patients with cardiovascular disease. Likewise, studies are needed to understand if VL is benefic in a normal airway. Cost-benefit studies would be useful to understand if VL is a viable substitution to DL.