Efficacy of Videolaryngoscopy Compared with Direct Laryngoscopy for Tracheal Intubation in Adult Patients: A Systematic Review

Abstract

Adequate airway management is essential in medical practice, with orotracheal intubation (OTI) considered a definitive procedure for airway control. Historically, direct laryngoscopy (DL) has been the standard technique; however, anatomical variations and clinical conditions may impair glottic visualization, increasing failure rates. Videolaryngoscopy (VL) has emerged as a technological advancement, allowing indirect visualization and potentially greater safety. Therefore, this study aimed to evaluate the efficacy and safety of VL compared with DL for tracheal intubation in adult patients. This is a systematic literature review based on randomized clinical trials and recent meta-analyses retrieved from databases such as PubMed and the Cochrane Library. The analysis showed that VL provided higher first-attempt success rates, better glottic visualization, and reduced severe complications in both elective settings, such as the operating room, and critical care environments, including intensive care units and emergency departments. This benefit was also observed in complex intubations, such as nasotracheal intubation and double-lumen tube placement. VL demonstrated consistent superiority over DL, supporting its progressive adoption as a first-line approach to improve patient safety, without eliminating the need for continuous training in conventional techniques.