Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV road, Pathumwan, Bangkok, 10330, Thailand.
Department of Emergency Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
BMC Emerg Med. 2021 Mar 25;21(1):37. doi: 10.1186/s12873-021-00434-2.
It is recommended that difficult airway predictors be evaluated before emergency airway management. However, little is known about how patients with difficult airway predictors are managed in emergency departments. We aimed to explore the incidence, management and outcomes of patients with difficult airway predictors in an emergency department.
We conducted a retrospective study using intubation data collected by a prospective registry in an academic emergency department from November 2017 to October 2018. Records with complete assessment of difficult airway predictors were included. Two categories of predictors were analyzed: predicted difficult intubation by direct laryngoscopy and predicted difficult bag-mask ventilation. The former was evaluated based on difficult external appearance, mouth opening and thyromental distance, Mallampati score, obstruction, and limited neck mobility as in the mnemonic "LEMON". The latter was evaluated based on difficult mask sealing, obstruction or obesity, absence of teeth, advanced age and reduced pulmonary compliance as in the mnemonic "MOANS". The incidence, management and outcomes of patients with these difficult airway predictors were explored.
During the study period, 220 records met the inclusion criteria. At least 1 difficult airway predictor was present in 183 (83.2%) patients; 57 (25.9%) patients had at least one LEMON feature, and 178 (80.9%) had at least one MOANS feature. Among patients with at least one difficult airway predictor, both sedation and neuromuscular blocking agents were used in 105 (57.4%) encounters, only sedation was used in 65 (35.5%) encounters, and no medication was administered in 13 (7.1%) encounters. First-pass success was accomplished in 136 (74.3%) of the patients. Compared with patients without predictors, patients with positive LEMON criteria were less likely to receive neuromuscular blocking agents (OR 0.46 (95% CI 0.24-0.87), p = 0.02) after adjusting for operator experience and device used. There were no significant differences between the two groups regarding glottic view, first-pass success, or complications. The LEMON criteria poorly predicted unsuccessful first pass and glottic view.
In emergency airway management, difficult airway predictors were associated with decreased use of neuromuscular blocking agents but were not associated with glottic view, first-pass success, or complications.
建议在紧急气道管理之前评估困难气道预测因素。然而，对于具有困难气道预测因素的患者在急诊科如何管理，知之甚少。我们旨在探讨急诊科具有困难气道预测因素的患者的发生率、处理方法和结局。
我们使用前瞻性登记处在学术急诊科收集的插管数据进行了回顾性研究，研究时间为 2017 年 11 月至 2018 年 10 月。纳入了完整评估困难气道预测因素的记录。分析了两类预测因素：直接喉镜预测的困难插管和预测的困难面罩通气。前者根据困难的外部外观、张口度和甲状软骨-下颌距离、Mallampati 评分、阻塞和颈部活动度受限进行评估，可用记忆术“LEMON”表示。后者根据面罩密封困难、阻塞或肥胖、无牙、高龄和肺顺应性降低进行评估，可用记忆术“MOANS”表示。探讨了这些困难气道预测因素患者的发生率、处理方法和结局。
在研究期间，符合纳入标准的记录有 220 份。183 例（83.2%）患者至少存在 1 个困难气道预测因素；57 例（25.9%）患者至少存在 1 个 LEMON 特征，178 例（80.9%）患者至少存在 1 个 MOANS 特征。在至少存在 1 个困难气道预测因素的患者中，105 例（57.4%）患者同时使用镇静剂和神经肌肉阻滞剂，65 例（35.5%）患者仅使用镇静剂，13 例（7.1%）患者未使用任何药物。136 例（74.3%）患者首次插管成功。与无预测因素的患者相比，LEMON 阳性标准的患者在调整操作者经验和使用设备后，更不可能使用神经肌肉阻滞剂（比值比 0.46（95%CI 0.24-0.87），p=0.02）。两组之间的声门显露、首次插管成功率或并发症无显著差异。LEMON 标准对首次插管不成功和声门显露的预测效果较差。
在紧急气道管理中，困难气道预测因素与减少使用神经肌肉阻滞剂相关，但与声门显露、首次插管成功率或并发症无关。
