In a study of 904 tracheal intubations in 809 children, Sasu et al. showed that using a C-MAC® videolaryngoscope (Karl Storz, Tuttlingen, Germany) reduced the incidence of poor glottic views from 13% to 4% [1]. They also found the modified six-grade Cormack and Lehane system ineffective for predicting the ease of videolaryngoscopic tracheal intubation. The primary outcome of this study was defined as vocal cords only just or not visible. Restricted glottic views in the modified Cormack and Lehane classifications 2b, 2c and 3 during videolaryngoscopy in adult and paediatric patients are typically due to an enlarged epiglottis and impaired epiglottic movement. Such issues can be resolved by correct head positioning, increased lifting force, directly lifting the epiglottis or external laryngeal manipulation [2-4]. However, the results do not specify whether these techniques were applied to enhance the view of the glottis, leaving us unsure if the observed glottic view grades represent the best possible outcome using both modes of laryngoscopy, particularly direct laryngoscopy that requires aligning the three airway axes for proper visualisation.

Difficult videolaryngoscopic tracheal intubation was documented as a difficult airway alert based on the videolaryngoscopic intubation and difficult airway classification (VIDIAC) score in adult patients with anticipated difficult airways. Kohse et al. classified difficulty into four levels using VIDIAC scores [2], but it is unclear whether a score of 1, which indicates a 50% probability of a difficult airway, was counted as difficult in this study. Although the VIDIAC score was a secondary outcome, its results were not reported, nor was its effectiveness in differentiating easy from difficult videolaryngoscopic tracheal intubations in paediatric patients analysed, despite most having normal airways. Clarifying these aspects could strengthen the conclusions.

The overall first attempt tracheal intubation success rate is significantly lower at 67% compared with a rate of 86.8% in a previous study, which focused on children undergoing elective airway management using videolaryngoscopes with standard blades [5]. Similarly, the success rate for first attempt tracheal intubation in children aged ≤ 1 y (48%) is much lower than the rate in a recent trial studying urgent tracheal intubations in newborns using C-MAC videolaryngoscopy (74%) [6]. Based on our own experience and existing studies [7], a stylet aids in directing the tracheal tube tip to the glottis and enhances tracheal intubation performance with the C-MAC videolaryngoscopy, even when there is a clear view of a child's vocal cords. Hence, we would like to know if a stylet was used in all cases.

在一项对 809 名儿童的 904 次气管插管的研究中，Sasu 等人表明，使用 C-MAC® 电子喉镜（Karl Storz，Tuttlingen，德国）可将声门视野不良的发生率从 13% 降低到 4% [1]。他们还发现改良的 6 级 Cormack 和 Lehane 系统对预测视频喉镜气管插管的难易程度无效。本研究的主要结果被定义为声带仅可见或不可见。成人和儿童患者在视频喉镜检查中改良的 Cormack 和 Lehane 分类 2b、2c 和 3 中的声门视野受限通常是由于会厌扩大和会厌运动受损。这些问题可以通过正确的头部定位、增加提升力、直接提升会厌或喉外操作来解决 [2-4]。然而，结果并未说明这些技术是否用于增强声门的视野，这使得我们不确定观察到的声门视野等级是否代表了使用两种喉镜模式的最佳结果，特别是直接喉镜检查，它需要对齐三个气道轴才能正确显示。

根据预期困难气道成年患者的视频喉镜插管和困难气道分类 （VIDIAC） 评分，困难视频喉镜气管插管被记录为困难气道警报。Kohse 等人使用 VIDIAC 评分将困难分为四个级别 [2]，但尚不清楚 1 分（表示困难气道概率为 50%）是否在本研究中被视为困难。尽管 VIDIAC 评分是次要结局，但未报告其结果，也不报告其在区分儿科患者轻松和困难视频喉镜气管插管方面的有效性，尽管大多数患者气道正常。澄清这些方面可以加强结论。

总体首次尝试气管插管成功率显著降低，为 67%，而之前一项研究的初次尝试成功率为 86.8%，该研究的重点是使用标准刀片的电子喉镜进行择期气道管理的儿童 [5]。同样，1 岁≤儿童首次尝试气管插管的成功率 （48%） 远低于最近一项使用 C-MAC 视频喉镜研究新生儿紧急气管插管的试验 （74%） [6]。根据我们自己的经验和现有研究 [7]，管心针有助于将气管插管尖端引导至声门，并通过 C-MAC 视频喉镜检查提高气管插管性能，即使可以清楚地看到儿童的声带。因此，我们想知道是否在所有情况下都使用了探针。