Airways ultrasound in predicting difficult face mask ventilation

Bianchini, Amedeo; Nardozi, Ludovica; Nardi, Elena; Scuppa, Maria Francesca

doi:10.23736/s0375-9393.20.14455-9

Cited by 16 publications

(12 citation statements)

References 41 publications

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“…After the selection process, 31 studies were included in this systematic review: all were observational studies, 30 were prospective observational studies and one had a retrospective design (Supplement 2, http://links.lww.com/EJA/A799). 9,12,22–50 …”

Section: Resultsmentioning

confidence: 99%

“…Overall, only two articles reported data on the role of ultrasound assessment in predicting difficult mask ventilation 9,23 . In one study difficult mask ventilation was evaluated through the Han scale, that is divided in grades 1 to 4 with or without muscle relaxant (grade 0 is referred to ‘ventilation by mask not attemped’); five ultrasonographic parameters were investigated in order to identify predictors of difficult mask ventilation 9,52 .…”

Section: Resultsmentioning

confidence: 99%

“…In some studies, obese and morbidly obese patients were defined as specific subgroups, 12,39,43,44,46,48 but in other studies obesity was considered as an exclusion criterion. 28,29,33,37,42,50 Most studies did not describe the head and neck position used for intubation: 10 reported the use of the sniffing position, 12,23,24,32,36,38,39,41,44,45 and two studies described the use of the ramped position for obese patients. 39,43 The use of external laryngeal manipulation was not permitted in seven studies, 34,[36][37][38]40,44,45 while it was allowed in others.…”

Section: Resultsmentioning

confidence: 99%

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Pre-operative ultrasound prediction of difficult airway management in adult patients

Giordano

Alessandri

Zulian

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPredicting a difficult airway, including difficult laryngoscopy, intubation or mask ventilation, is paramount in peri-operative management. As clinical predictors are only partially reliable, ultrasound-based measurements might be useful in evaluating anterior neck fat tissues depth.OBJECTIVESThe aim of this systematic review is to report clinical evidence on pre-operative ultrasound as a predictor of difficult laryngoscopy, difficult intubation or difficult mask ventilation.DESIGNA systematic review of randomised controlled trials and observational studies.DATA SOURCESThe MEDLINE, EMBASE and Google Scholar databases were queried from inception until 28 February 2022.ELIGIBILITY CRITERIAStudies involving adult patients who had undergone orotracheal intubation after evaluation with airways ultrasound were considered suitable. Exclusion criteria were a clinical history of difficult airways, cancer or trauma, pregnancy, supraglottic airway devices, video-laryngoscopy. Parameters were classified by reporting their accuracy in discriminating ‘difficult’ vs. ‘not difficult’ laryngoscopy, intubation or mask ventilation.RESULTSThirty-one observational studies were included and a total of 41 single parameters and 12 different combinations of clinical and ultrasound parameters were reported. The distance from skin to epiglottis midway with neutral position of head and neck, the distance from hyoid bone to skin surface with a neutral position of head and neck and the hyomental distance extended/neutral ratio are the most associated with difficult laryngoscopy or difficult intubation. A combination of clinical and ultrasound parameters (a modified Mallampati score, the distance from the skin to the epiglottis midway with neutral position of the head and neck, and the USED-MSH score) showed high accuracy. Only two studies reported the role of ultrasound in predicting difficult mask ventilation: the distance from hyoid bone to skin surface with neutral position of head and neck, the thickness of the base of the tongue with hyperextension of the head, and the hyomental distance with hyperextension of the head and active subluxation of the mandible are the parameters with the highest correlation.CONCLUSIONSThe use of ultrasound parameters might be useful in predicting difficult laryngoscopy or difficult intubation. Several ultrasound parameters and combinations have been associated with difficult laryngoscopy or difficult intubation prediction. The use of scores combining clinical predictors and ultrasound measures are very promising. Data on difficult mask ventilation are scarce and the role of ultrasound is still controversial. Future studies are needed.CLINICAL TRIAL REGISTRATIONCRD42021250574.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Pre-operative ultrasound prediction of difficult airway management in adult patients

Giordano

Alessandri

Zulian

et al. 2023

European Journal of Anaesthesiology

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“…Finally, it has been suggested that the thickness of the base of the tongue (SBL) and hyoid mental distance with hyperextension of the head and subluxation of the mandible (DIMs) could effectively predict difficult mask ventilation, which may be caused by thick tongue could be displaced more posteriorly after anaesthesia, and reduced the air space also at the level of the oropharynx and hypopharynx limiting the airflow coming 11 . However, our study did not include difficult mask ventilation into the outcomes, because other studies suggested that mask ventilation could be facilitated by muscle relaxation after anaesthesia in adults 38,39 , it was quite controversial.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound measurements for evaluation of changes in upper airway during anaesthesia induction and prediction difficult laryngoscopy: a prospective observational study

Wang

Zheng

et al. 2022

Sci Rep

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Upper airway collapsibility after anaesthesia induction may be associated with unpredictable difficult airway. However, most works on airway anatomy are tended to morphological description before anaesthesia. This study aimed to evaluate the changes of upper airway after anaesthesia induction and using pre-anesthetic ultrasound measurements to predict Difficult Laryngoscopy (DL). We included 104 eligible subjects with complete data, who were performed tracheal intubations under general anaesthesia in the study. The upper airway changes before and after anaesthesia induction were determined by seven neck ultrasound measurements, included as follow: (1) Distance from skin to under surface of Tongue (DT), (2) Thickness of the thickest part of Tongue body (TT), (3) Hyoid Mental Distance (HMD), (4) Depth of Hyoid (DH), (5) Width of Hyoid (WH), (6) Distance from Skin to Epiglottis (DSE), (7) Depth of the anterior combination of the Vocal Cords (DVC). DL was evaluated with Cormack–Lehane (CL). Data regarding HMD [from 45.3 (42.4–48.5) to 41.1 (38.5–44.9) mm], DH [from 8.7 (6.6–10.9) to 7.0 (5.3–9.1) mm], DSE [from 20.1 (16.6–22.5) to 19.5 (16.5–21.6) mm] and the DVC [from 7.1 (5.7–8.3) to 6.8 (5.7–7.9) mm] were decreased (P < 0.05), while the DT [from 15.9 (13.1–18.4) to 17.4 (14.5–19.8) mm] was increased (P > 0.05) after anaesthesia induction. Additionally, when cut-off value of DSE was 21.25 mm before anaesthesia, it may be better predicted to DL [sensitivity 80.0% (95% CI: 60.7–91.6%) and specificity 83.8% (95% CI: 73.0–91.0%)]. The upper airway after induction showed the propensity of collapsibility by ultrasound measurements. Compared with other indicators, the DSE assessed by ultrasound might be considered to a valuable predictor of DL.Trial registration: The study was registered in ClinicalTrials.gov on 23th Jan 2019, ChiCTR1900021123.

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“…Li et al [ 18 ] reported that measurement of the submental portion by ultrasound is predictive of difficult mask ventilation. Bianchini et al [ 19 ] reported that tongue base thickness is predictive of difficult mask ventilation. Enlargement of the tongue base or submental portion can cause airway narrowing.…”

Section: Can Airway Ultrasound Predict a Difficult Airway?mentioning

confidence: 99%

Airway ultrasound for patients anticipated to have a difficult airway: Perspective for personalized medicine

Nakazawa¹,

Uzawa²,

Tokumine³

et al. 2023

World J Clin Cases

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Airway ultrasound allows for precise airway evaluation, particularly for assessing the difficult airway and the potential for front of neck access. Many studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital palpation. However, no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of cricothyroidotomy. This is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision making. The role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is proposed. The goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.

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Airways ultrasound in predicting difficult face mask ventilation

Cited by 16 publications

References 41 publications

Pre-operative ultrasound prediction of difficult airway management in adult patients

Pre-operative ultrasound prediction of difficult airway management in adult patients

Ultrasound measurements for evaluation of changes in upper airway during anaesthesia induction and prediction difficult laryngoscopy: a prospective observational study

Airway ultrasound for patients anticipated to have a difficult airway: Perspective for personalized medicine

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