Unlike traditional endotracheal intubation methods, videolaryngoscopes are equipped with a camera, enabling real-time view of the larynx during the procedure. According to literature, videolaryngoscopy is known to significantly improve first-attempt success rates, which is of extreme relevance given that additional intubation attempts increase the risk of trauma, hypoxaemia and adverse cardiovascular events (Aziz MF. et al., 2016; Prekker ME. et al., 2023).
Since the introduction of the GlideScope® in 2001, which marked the beginning of modern videolaryngoscopy, these devices have progressively demonstrated their value in airway management. However, despite the growing body of evidence supporting their use, their adoption in routine clinical practice remains limited.
Barriers to the adoption of videolaryngoscopy
Both patients and clinicians stand to benefit from the transition to videolaryngoscopy; however, several barriers to its widespread adoption persist. The acquisition of these devices may exert significant pressure on hospital budgets, particularly in settings where resources are already constrained, while maintenance and technological updates also require sustained financial investment.
The adoption of videolaryngoscopy may also be hindered by resistance to change from established clinical practices, as well as by institutional dynamics that do not always facilitate the integration of new technologies. In addition, concerns regarding the environmental impact of single-use components, together with logistical challenges related to storage and supply management, may further limit implementation. In rural and lower-income settings, restricted access to such devices may represent an additional constraint.
Why videolaryngoscopy should be the primary option for endotracheal intubation
Today, a growing body of clinical evidence shows that videolaryngoscopy:
- Increases the likelihood of first-attempt success.
- Reduces the time required for the intubation procedure.
- Reduces intubation-related complications.
- Minimises the physiological burden on the patient.
In addition, the use of videolaryngoscopy may reduce clinicians’ psychological stress and increase confidence, thereby potentially enhancing performance and improving the overall procedural experience.
This improved performance has led many experts to advocate for videolaryngoscopy as the preferred primary approach for endotracheal intubation in routine clinical practice, where appropriate.
Videolaryngoscopes might be more cost-efficient in the long-term
The costs of videolaryngoscopes have decreased over time. According to experts, this reduction, together with the lower incidence of patient complications and fewer intubation attempts, may render this technique more cost-effective in the long term.
Conclusion
Moving from scientific evidence to routine clinical practice can take decades. Therefore, achieving the widespread adoption of videolaryngoscopy as the preferred approach will require more than robust clinical evidence alone. Continued technological development (for example, aimed at reducing costs and standardising devices), together with supportive public health policies, equipment funding programmes, hands-on training, and medical education initiatives, will be essential to accelerate the transition towards safer and more efficient intubation practices.
Within this context, ongoing innovation continues to play an important role. The Airway Shield™ is a medical device designed to facilitate Endotracheal Intubation by guiding the tube towards the vocal cords, while also providing protection for clinicians against potential exposure to aerosols and for patients against dental and mucosal trauma. The device is compatible with a wide range of videolaryngoscopes available on the market. This approach is also consistent with current airway management guidelines, which advocate for the use of videolaryngoscopy as the first-line approach for tracheal intubation.
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References:
Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. (2016). Success of intubation rescue techniques after failed direct laryngoscopy in adults. Anesthesiology, 125(4):656–666. doi:10.1097/ALN.0000000000001267.
Prekker ME, Driver BE, Trent SA, et al. (2023). Video versus direct laryngoscopy for tracheal intubation of critically ill adults. New England Journal of Medicine, 389(5):418–429. doi:10.1056/NEJMoa2301601.
Gómez-Ríos MA, Van Zundert AAJ, McNarry AF, et al. (2025). Guidelines on strategies for the universal implementation of videolaryngoscopy. Eur J Anaesthesiol, 42(10):872–888. doi:10.1097/EJA.0000000000002210.