Videolaryngoscopes continue to garner significant attention due to their technical advantages over traditional direct laryngoscopy, including higher first-pass success rates and improved visualisation of glottic structures [1]. Despite compelling evidence and recommendations [2], their use falls short of these guidelines and direct laryngoscopy remains the first choice of device for most clinicians [3]. This disparity raises questions about some of the underlying factors that influence the implementation of videolaryngoscopy in everyday practice. A specific area that warrants closer examination is the usability and user experience associated with video compared with direct laryngoscopy. Usability encompasses the extent to which a product can be utilised to achieve specific goals with effectiveness, efficiency and satisfaction within a designated context of use [4]. To investigate this, a usability study was conducted comparing the experiences of healthcare professionals using both types of devices. The study employed the system usability scale, a validated tool in heuristics and device ergonomics that measures usability through 10 questions rated on a Likert scale, yielding scores from 0 to 100. Higher scores indicate better usability. Participants were recruited via an online questionnaire distributed over a 1-week period and asked to comment on their experiences using Macintosh profile direct laryngoscopes and videolaryngoscopes (online Supporting Information Appendix S1). The survey was sent to a department group consisting of 54 anaesthetists, and 20 respondents with > 5 years of clinical experience with both devices participated in the survey. A minimum number of 20 participants has been established as the acceptable number required to produce valid results when conducting usability studies [5].

Although the study results are somewhat limited by a relatively low response rate and total number of participants, the system usability scale scores revealed a notable disparity in usability between the two devices. Mean (SD) system usability scale score for the direct laryngoscope was 86.6 (8.0), while videolaryngoscopes scored significantly lower at 72.5 (5.5) (p = 0.007). The largest discrepancies were observed in the domains relating to device variability and perceived complexity. Participants reported that videolaryngoscopes were unnecessarily complex, which detracted from their overall usability. The findings suggest that user experience is an important factor influencing the adoption of videolaryngoscopy in clinical practice, with a significant barrier being the relative complexity associated with their set-up and maintenance. Clinicians are more likely to resort to using a videolaryngoscope only where this complexity is deemed necessary, for example anticipated airway difficulty.

To address these usability concerns, as education and clinical studies may have reached a point of saturation [6], our focus should be on the design aspects of videolaryngoscopes in line with the principle of the hierarchy of controls [7], which emphasises that the most effective change can be achieved through improved design. Specifically, the following measures should be explored further: standardising videolaryngoscopes to reduce the considerable variability that exists among different models; and further developing devices that require a setup process as straightforward as that of the direct laryngoscope. Additionally, creating systems whereby the logistical burden of using videolaryngoscopes is minimised such as by adopting universal videolaryngoscopy practices within institutions, ensuring equipment is readily available, properly maintained and easily accessible as well as streamlining cleaning protocols to enhance user experience and acceptance.

While videolaryngoscopy offers clear clinical advantages, its broader adoption is hindered by issues related to usability and user experience. By addressing these challenges through design and systemic integration, we can foster a more favourable environment for routine use, potentially enhancing patient safety and tracheal intubation success rates.

视频喉镜因其相对于传统直接喉镜的技术优势而继续受到广泛关注，包括更高的首次通过成功率和改进的声门结构可视化[ 1 ]。尽管有令人信服的证据和建议 [ 2 ]，但其使用仍不符合这些指南，直接喉镜检查仍然是大多数临床医生的首选设备 [ 3 ]。这种差异引发了人们对影响视频喉镜在日常实践中实施的一些潜在因素的疑问。值得仔细检查的一个特定领域是与直接喉镜检查相比与视频相关的可用性和用户体验。可用性包括在指定的使用环境中，产品可以被用来实现特定目标的有效性、效率和满意度的程度[ 4 ]。为了调查这一点，进行了一项可用性研究，比较了医疗保健专业人员使用两种类型设备的体验。该研究采用了系统可用性量表，这是一种在启发式和设备人体工程学方面经过验证的工具，通过按李克特量表评分的 10 个问题来衡量可用性，得出 0 到 100 的分数。分数越高，表明可用性越好。通过在 1 周内分发的在线调查问卷招募参与者，并要求他们评论他们使用 Macintosh 配置文件直接喉镜和视频喉镜的体验（在线支持信息附录 S1）。该调查发送给由 54 名麻醉师组成的科室小组，其中 20 名具有 5 年以上两种设备临床经验的受访者参与了调查。 进行可用性研究时，产生有效结果所需的可接受人数已确定为至少 20 名参与者 [ 5 ]。

尽管研究结果在一定程度上受到相对较低的响应率和参与者总数的限制，但系统可用性量表得分显示两种设备之间的可用性存在显着差异。直接喉镜的系统可用性量表平均 (SD) 评分为 86.6 (8.0)，而视频喉镜的评分明显较低，为 72.5 (5.5) (p = 0.007)。在与设备可变性和感知复杂性相关的领域中观察到最大的差异。参与者报告说，视频喉镜过于复杂，这降低了其整体可用性。研究结果表明，用户体验是影响视频喉镜在临床实践中采用的重要因素，其中一个重大障碍是其设置和维护的相对复杂性。仅当这种复杂性被认为是必要的（例如预期的气道困难）时，临床医生才更有可能诉诸使用视频喉镜。

为了解决这些可用性问题，由于教育和临床研究可能已达到饱和点[ 6 ]，我们的重点应放在符合控制层次原则的视频喉镜的设计方面[ 7 ]，该原则强调最有效的改变可以通过改进设计来实现。具体而言，应进一步探讨以下措施：标准化视频喉镜，以减少不同型号之间存在的较大差异；并进一步开发需要像直接喉镜一样简单的设置过程的设备。此外，创建系统，最大限度地减少使用视频喉镜的后勤负担，例如在机构内采用通用视频喉镜做法，确保设备随时可用、正确维护和易于使用，并简化清洁方案以增强用户体验和接受度。

虽然视频喉镜具有明显的临床优势，但其更广泛的采用受到与可用性和用户体验相关的问题的阻碍。通过设计和系统集成来应对这些挑战，我们可以为常规使用营造一个更有利的环境，从而潜在地提高患者安全和气管插管的成功率。