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Pro-Con | Should VL be Standard of Care for Intubation?

April 26, 2023

Written by Rebecca White

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Video laryngoscopy (VL) has shown advantages over direct laryngoscopy (DL) in the literature, but should it be the primary approach to intubation? These two anesthesiologists debate.

Why does this matter?
We’ve seen repeatedly that VL increases first-pass success rate and results in fewer adverse outcomes including esophageal intubation and hypoxemia. Is it time to consider this the standard of care?

Go with what you know
In this Pro-Con commentary article written by two anesthesiologists, Author 1 argues that because VL outperforms DL across providers, environments, and patient conditions, it should be utilized universally as the primary intubation approach. While some argue that VL degrades clinical experience with DL, he states that patient care is advancing, similar to the use of ultrasound over landmark-guided central lines. Cost of VL systems has continued to decrease; these should be present in all intubating environments.

Author 2 counters that no single intubation method should be considered the standard of care; this implies other methods are inappropriate, and proficiency in these methods will not be maintained. Instead, all providers should plan a primary and several back-up methods of airway management. VL is associated with a higher failure rate than DL in passing the tube with a good view of the vocal cords and has shown increased time to intubation. DL systems are more cost-effective and less prone to technological failure.

Overall, the consensus of both is that providers should default to the method with which they are most comfortable and should always have a back-up approach (or several) in their arsenal.

Pro-Con Debate: Videolaryngoscopy Should Be Standard of Care for Tracheal Intubation. Anesth Analg. 2023 Apr 1;136(4):683-688. doi: 10.1213/ANE.0000000000006252. Epub 2023 Mar 16.

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