Prediction of Difficult Laryngoscopy Using Ultrasound: A Systematic Review and Meta-Analysis

Bhargava, Vidit; Rockwell, Nicholas; Tawfik, Daniel S.; Haileselassie, Bereketeab; Petrișor, Cristina; Su, Erik

doi:10.1097/ccm.0000000000005711

Cited by 9 publications

(19 citation statements)

References 54 publications

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“…[ 11 ] A recent systematic review showed that airway ultrasound metrics were associated with difficult laryngoscopy in three domains: anterior tissue thickness, anatomical position, and oral space. [ 12 ]…”

Section: Airway Assessmentmentioning

confidence: 99%

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Recent advances in airway management

et al. 2023

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Airway management is a core skill essential for anaesthesiologists and health care providers involved in resuscitation and acute care of patients. Advancements in airway management are continuously evolving. This narrative review highlights the recent advancements with respect to innovations, tools, techniques, guidelines, and research in both technical and non-technical aspects of airway management. These include nasal endoscopy, virtual endoscopy, airway ultrasound, video endoscopes, supraglottic airways with enhanced protection against aspiration, hybrid devices, and the use of artificial intelligence and telemedicine, the utility of which has increased in recent times, thereby improving success with airway management and enhancing patient safety. There has been an increasing emphasis on peri-intubation oxygenation strategies to reduce complications in patients with a physiologically difficult airway. Recent guidelines for difficult airway management and preventing unrecognised oesophageal intubation are available. Large multicentre airway data collection helps us examine airway incidents, aetiology, and complications to expand our knowledge and give us insights for change in practice.

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Section: Airway Assessmentmentioning

confidence: 99%

“…Combining clinical and ultrasound assessments may form an accurate screening tool for difficult laryngoscopy in the future. [ 12 ]…”

Section: Airway Assessmentmentioning

confidence: 99%

Recent advances in airway management

et al. 2023

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“…However, the presence of a large amount of heterogeneity in the study methodology, measurement thresholds, and population groups has prevented the generalization of these tools at the bedside. Recent studies have suggested the role of assessment instruments combining clinical and ultrasound methods to predict difficult laryngoscopy more accurately 66 . Most of these studies have been done in adults, and few studies evaluate these metrics in children.…”

Section: Predicting Difficult Laryngoscopymentioning

confidence: 99%

“…The predictive value of individual tests is low due to the lack of standardized measurements, agreed‐upon cut‐off values, and the subjectivity of examination. However, a combination of multiple ultrasound metrics and clinical examination can predict difficult laryngoscopy with greater accuracy than a single measurement alone 66 . Very few studies have evaluated difficult laryngoscopy using ultrasound in pediatric patients 69 …”

Section: Predicting Difficult Laryngoscopymentioning

confidence: 99%

A Scoping Review of Ultrasonographic Techniques in the Evaluation of the Pediatric Airway

Burton

Bhargava

2023

J of Ultrasound Medicine

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Point of care ultrasound is making rapid advancements in pediatrics, and ultrasonographic assessment of the airway is being employed in many specialties such as the pediatric, cardiac, and neonatal intensive care units, emergency department, pulmonary clinic, and the perioperative setting. This scoping review provides a technical description of image acquisition and interpretation, accompanying ultrasound images of the hallmark airway applications in pediatrics, and supporting evidence when available. We describe and illustrate ultrasound‐determined endotracheal tube (ETT) sizing, ETT placement and depth confirmation, vocal fold assessment, prediction of post‐extubation stridor, difficult laryngoscopy prediction, and cricothyrotomy guidance. This review aims to provide the descriptions and images necessary to learn and apply these skills at the point of care in the pediatric patient.

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“…We appreciate the opportunity to respond to the communication by Foley (1) regarding our recently published article (2).…”

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confidence: 99%

The authors reply

Bhargava

2023

Critical Care Medicine

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W e appreciate the opportunity to respond to the communication by Foley (1) regarding our recently published article (2).We agree with the concept that difficult laryngoscopy is already appropriately defined, and this article's purpose is instead to examine ultrasound measures that may be associated with difficult laryngoscopy. The larger goal is the noninvasive assessment of an airway and prediction of any difficult issues before induction and laryngoscopy. We hope that we all can agree that preprocedure preparation is valuable when an intubating clinician suspects difficult laryngoscopy based on predictive risk factors. Ultrasound can play a role in this.Foley (1) notes that the existing evidence has not included patients with structural abnormalities and burns using these methodologies. Therefore, a meta-analysis of data on that population is not practical. However, a broad and functional understanding of the technique based on existing literature will facilitate the developing of effective protocols and methods. These protocols in turn would be crucial for studying difficult laryngoscopy prediction in the smaller and more heterogeneous population of patients with known structural airway abnormalities and burns.We appreciate the questions by Foley (1) about the role of these findings in clinical medicine. To summarize the stated objective of the article, it was to summarily evaluate the published evidence on associations between ultrasound measures and difficult laryngoscopy. Knowing that there have been other systematic reviews (citations 44-8 in the manuscript) that concluded that the published literature reflects heterogeneous methods and patients, our article categorized the assessments into domains and analyzed them separately in the interest of facilitating a multistep ultrasound assessment. As this multistep methodology appears promising in our article and could perhaps be even more accurate with incorporating nonimaging clinical data, its development and testing could be an important next step in this arena.Responding to the question of whether it is a research tool, the robust literature that exists on the topic suggests that it already has been evolving. As has been demonstrated in point-of-care ultrasound methodologies such as gastric ultrasound for evaluation of nil per os status and research modalities, once optimized for clinical use can one day become standardized methods endorsed by the American Board of Anesthesiology for Critical Care Medicine subspecialty certification.

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Prediction of Difficult Laryngoscopy Using Ultrasound: A Systematic Review and Meta-Analysis

Cited by 9 publications

References 54 publications

Recent advances in airway management

Recent advances in airway management

A Scoping Review of Ultrasonographic Techniques in the Evaluation of the Pediatric Airway

The authors reply

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