A simplified risk score to predict difficult intubation: development and prospective evaluation in 3763 patients

Eberhart, Leopold; Arndt, Christian; Aust, H.; Kranke, Peter; Zoremba, Martin; Morin, A. M.

doi:10.1097/eja.0b013e328338883c

Cited by 28 publications

(16 citation statements)

References 19 publications

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“…However, logistic regression showed that an increase in one unit means that the likelihood of difficult intubation is 1.27 times higher. In most cases, greater neck circumference is associated with high body weight and some scoring models include weight as a risk factor for difficult intubation 8,[13][14][15] . We did not confirm that.…”

Section: Discussionmentioning

confidence: 99%

Can Difficult Intubation Be Easily and Rapidly Predicted?

Fritscherova

Adamus²,

Dostalova³

et al. 2011

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. Failed endotracheal intubation and inadequate ventilation with subsequent insufficient oxygenation can result in serious complications potentially leading to permanent health damage. Difficult intubation may occur not only in patients with apparent pathologies in the orofacial region but also, unexpectedly, in those without abnormalities. This study aimed at finding anthropometric parameters that are easy to examine and that would aid in predicting difficult intubation.Method. A case-control study was undertaken. Based on defined criteria, 15 parameters were examined in patients with unanticipated difficult intubation. The parameters included a previous history of difficult intubation, pathologies associated with difficult intubation, clinical symptoms of airway pathology, the Mallampati score, upper lip bite test, receding mandible, and cervical spine and temporomandibular joint movement. Thyromental, hyomental and sternomental distances and inter-incisor gap were measured. The methods were precisely defined and the measurements were carried out by a trained anesthesiologist. Statistical analysis was performed on data from 74 patients with difficult intubation and 74 control patients with easy intubation.Results. Significant predictors of difficult intubation were inter-incisor gap (IIG), thyromental distance (TMD) and class 3 limited movement of the temporomandibular joint. The IIG and TMD cut-offs were set at 42 mm and 93 mm, respectively.Conclusion. The results will be used to confirm these predictors in an anesthesiology clinic along with the aid of the laryngoscopic findings to improve the prediction of unanticipated difficult intubation.

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Section: Discussionmentioning

confidence: 99%

Can Difficult Intubation Be Easily and Rapidly Predicted?

Fritscherova

Adamus²,

Dostalova³

et al. 2011

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…The anesthesia literature has demonstrated factors associated with difficult intubation (eg, obesity and short thyromental distance) [14][15][16][17]. By contrast, in the ED setting, the evidence to predict difficult airways remains scarce.…”

Section: Introductionmentioning

confidence: 98%

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Hagiwara

Watase

Okamoto

et al. 2015

The American Journal of Emergency Medicine

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“…Many studies 12,14,26,35 indicated that limited mouth opening is strongly associated with difficult intubation as observed by us. If IIG <3 cm is taken, then it becomes highly sensitive test (100%) for prediction of difficult intubation.…”

Section: Discussionmentioning

confidence: 95%

Predicting Difficult Intubation in Surgical Patients Scheduled for General Anaesthesia: A Prospective Study of 435 Patients

Naithani¹,

Gupta²,

Gupta³

et al. 2013

jemds

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BACKGROUND: Unanticipated difficult tracheal intubation is a significant source of morbidity and mortality in anaesthetic practice which can be reduced by identification of potential difficult intubation. OBJECTIVE: We aimed the present study to know the incidence of difficult intubation, factors associated with it and the predictive value of various airway predictors in anticipating difficult visualization of larynx and difficult intubation. METHODS: 435 adult patients (>18 year) undergoing general anaesthesia with intubation were examined preoperatively for demographic details (age, sex, weight), dentition, airway pathology and six airway predictors i.e. Inter Incisor Gap (IIG), Modified Mallampatti Grading (MMPG), Upper lip bite test (ULBT), Thyromental distance (TMD), Sternomental distance (SMD) and subluxation of mandible (SLM). All patients were anaesthetized using standard protocol with thiopentone (5mg/kg) and succinylcholine (1.5 mg/kg). On direct laryngoscopy, Cormack Lehane (CL) grading was noted. CL grade I, II was defined as easy visualization of larynx (EVL) and CL grade III, IV as difficult visualization of larynx (DVL). Difficult intubation score (DIS) was calculated as sum of CL grade and number of intubation attempts. DIS of less than or equal to 4 was defined as easy intubation (EI) and DIS > 4 was defined as difficult intubation (DI).Sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratios(LR) and odd's ratio value for six airway predictor tests was calculated by standard formulae. RESULTS: Incidence of DVL was 12.65% (n=55) and DI was 9.65% (n=42), with no failed intubation. All airway tests had very high negative predictive value (>90%) which implicates they identify easy intubations more precisely. MMPG and ULBT were found as nearly perfect airway predictors for difficult intubation having odds ratio of .7%) respectively, along with very high sensitivity of 92.80% and 85.7% respectively. Presence of ULBT III is the best predictor of difficult intubation (+LR 21.97) and absence of MMPG III, IV is the best predictor of difficult intubation (-LR 0.091). Abnormal dentition and airway pathology also increase the risk of difficult intubation, P<0.001. CONCLUSION: We conclude that ULBT and MMPG are "nearly perfect" airway predictors and should be used routinely during pre-anesthetic visit for screening of difficult intubation.

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A simplified risk score to predict difficult intubation: development and prospective evaluation in 3763 patients

Cited by 28 publications

References 19 publications

Can Difficult Intubation Be Easily and Rapidly Predicted?

Can Difficult Intubation Be Easily and Rapidly Predicted?

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Predicting Difficult Intubation in Surgical Patients Scheduled for General Anaesthesia: A Prospective Study of 435 Patients

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