Thyromental height test as a new method for prediction of difficult intubation with double lumen tube

Palczynski, Piotr; Białka, Szymon; Misiołek, Hanna; Copik, Maja; Smelik, Anna; Szarpak, Łukasz; Ruetzler, Kurt

doi:10.1371/journal.pone.0201944

Cited by 15 publications

(22 citation statements)

References 23 publications

(27 reference statements)

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“…In our study, SMD sensitivity was found to be 53.3%, speci city was 86.2%, PPV was 28.6%, NPV was 94.7%, and accuracy was 83.1%. These ndings are consistent with the results of Palczynski et al [40], who found a sensitivity of 60% and a PPV of 19% for SMD. A poor sensitivity and PPV for this test (8.3% and 3.4%, respectively) were observed by Khatiwada et al [41] and, in a study by Shobha et al [42], SMD sensitivity was found to be 3.3% and PPV was 6.25%.…”

Section: Discussionsupporting

confidence: 93%

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Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients: A prospective observational study

El-Radaideh

Dheeb

Shboul

et al. 2020

Preprint

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Background It is important to perform preoperative airway tests for prediction of difficult intubations because inadequate maintenance of a patient’s airway is still the major cause of anesthesia-related morbidity and mortality. Methods We conducted this study to determine which airway test, or combination of airway tests, was most clinically useful. One hundred sixty adult patients underwent preoperative assessments of the mandible protrusion test (MPT), thyromental (TMD) and sternomental (SMD) distances, inter-incisor gap (IIG), and the modified Mallampati tests with tongue protrusion (MMT-TP) and without tongue protrusion (MMT-NTP). Grade C on the MPT, TMD ≤ 6 cm, SMD ≤ 12 cm, and MMT grades III and IV were considered to be predictors of difficult tracheal intubations. A modified Cormack-Lehane grading (MCLG) of laryngoscopic views with backward, upward, and right-sided pressure on the thyroid and cricoid cartilages (BURP) maneuver was also documented, with grades 2B, 3, and 4 considered to be difficult airways for intubation. Results Fifteen patients (9.4%) were classified as MCLG 2B, 3, and 4, with age significantly associated with the MCLG grade (P = 0.028). The sensitivity and Youden's index of MMT-TP were found to be the lowest (40% and 0.29, respectively). The MPT was the most accurate and specific test (90.63% and 95.17%, respectively), with the highest PPV (50%), Youden's index (0.42), and area under the curve (AUC) (0.781). Bivariant analysis of MPT and the t-test of the mean TMDs and SMDs revealed significant associations between these airway tests and the difficulty of intubation (P values: < 0.001, 0.02, < 0.01, respectively). Conclusion The MPT, with its highest accuracy, specificity, positive predictive value, and good sensitivity may be used as a routine screening test for preoperative prediction of difficult tracheal intubations.

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Section: Discussionsupporting

confidence: 93%

“…Bindra et al [39], however, found no signi cant changes in the diagnostic performance of the MMT-TP in the sitting or the supine positions. SMD is anatomically easy to measure and is commonly used in clinical practice [40].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients: A prospective observational study

El-Radaideh

Dheeb

Shboul

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Recent advances in airways adjuncts like the introduction of videolaryngoscopes into clinical practice have led to fewer life-threatening complications, however the risk of serious complications still remains. Despite protracted convalescent, the current definitions to predict difficult airway situations are inadequate and often times prove unchallenging [3,4]. Conversely, unanticipated difficult airway scenarios occur when least expected and significantly lead to anesthesia-related morbidity.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

et al. 2020

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Background: Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods: We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results: Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization.

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“…Khan et al [35] demonstrated that the Mallampati test correctly depicts di cult intubations when the test is performed without phonation. SMD is anatomically easy to measure and is commonly used in clinical practice [40].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients undergoing surgical procedures.

El-Radaideh

Dheeb

Shboul

et al. 2020

Preprint

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Background: Inadequate maintenance of a patient's airway represents a major cause of anesthesia-related morbidity and mortality. This study was designed to evaluate common preoperative clinical tests to determine the risk of difficult endotracheal intubation in apparent "normal" adult patients undergoing surgical procedures.Methods: A prospective observational cohort study was performed on 160 consecutive adult patients undergoing surgical procedures at an academic medical center in Jordan from 20 May 2019 until 11 February 2020. Preoperative assessment of airway risk stratification was performed by the following clinical tests: the mandible protrusion test (MPT), thyromental (TMD) and sternomental (SMD) distances, inter-incisor gap (IIG), and the modified Mallampati tests with tongue protrusion (MMT-TP) and without tongue protrusion (MMT-NTP). Grade C on the MPT, TMD ≤ 6 cm, SMD ≤ 12 cm, and MMT grades III and IV were considered to be predictors of difficult endotracheal intubations. A modified Cormack-Lehane grading (MCLG) of laryngoscopic views with backward, upward, and right-sided pressure on the thyroid and cricoid cartilages (BURP) maneuver was also documented, with grades 2B, 3, and 4 considered to be difficult airways for intubation. Results: Fifteen patients (9.4%) were classified as MCLG 2B, 3, and 4, with age significantly associated with the MCLG grade (P = 0.028). The sensitivity and Youden's index of MMT-TP were found to be the lowest (40% and 0.29, respectively). The MPT was the most accurate and specific test (90.63% and 95.17%, respectively), with the highest PPV (50%), Youden's index (0.42), and area under the curve (AUC) (0.781). Bivariant analysis of MPT and the t-test of the mean TMDs and SMDs revealed significant associations between these airway tests and the difficulty of intubation (P values: < 0.001, 0.02, < 0.01, respectively). Conclusion: The MPT, with its highest accuracy, specificity, positive predictive value, and good sensitivity may be used as a routine screening test for preoperative prediction of difficult endotracheal intubations.

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Thyromental height test as a new method for prediction of difficult intubation with double lumen tube

Cited by 15 publications

References 23 publications

Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients: A prospective observational study

Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients: A prospective observational study

Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial

Evaluation of different airway tests to determine difficult intubation in apparently normal adult patients undergoing surgical procedures.

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