Giordano Giovanni, Alessandri Francesco, Zulian Aurora, Bilotta Federico, Pugliese Francesco
From the Department of General Surgery, Surgical Specialties and Organ Transplantation 'Paride Stefanini', Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
Eur J Anaesthesiol. 2023 May 1;40(5):313-325. doi: 10.1097/EJA.0000000000001805. Epub 2023 Feb 6.
Predicting 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.
The 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.
A systematic review of randomised controlled trials and observational studies.
The MEDLINE, EMBASE and Google Scholar databases were queried from inception until 28 February 2022.
Studies 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.
Thirty-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.
The 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.
CRD42021250574.
预测困难气道，包括困难喉镜检查、插管或面罩通气，在围手术期管理中至关重要。由于临床预测指标仅部分可靠，基于超声的测量可能有助于评估颈部前方脂肪组织深度。
本系统评价的目的是报告术前超声作为困难喉镜检查、困难插管或困难面罩通气预测指标的临床证据。
对随机对照试验和观察性研究的系统评价。
检索MEDLINE、EMBASE和谷歌学术数据库，检索时间从建库至2022年2月28日。
纳入对成年患者在气道超声评估后进行经口气管插管的研究。排除标准为困难气道、癌症或创伤的临床病史、妊娠、声门上气道装置、视频喉镜检查。通过报告各参数在区分“困难”与“非困难”喉镜检查、插管或面罩通气方面的准确性进行分类。
纳入31项观察性研究，共报告了41个单一参数以及12种不同的临床和超声参数组合。头颈部中立位时皮肤至会厌中点的距离、头颈部中立位时舌骨至皮肤表面的距离以及颏下距离伸展位/中立位比值与困难喉镜检查或困难插管相关性最强。临床和超声参数的组合（改良马兰帕蒂评分、头颈部中立位时皮肤至会厌中点的距离以及USED-MSH评分）显示出较高的准确性。仅有两项研究报告了超声在预测困难面罩通气中的作用：头颈部中立位时舌骨至皮肤表面的距离、头部过伸时舌根厚度以及头部过伸且下颌骨主动半脱位时的颏下距离是相关性最高的参数。
超声参数的应用可能有助于预测困难喉镜检查或困难插管。若干超声参数及组合与困难喉镜检查或困难插管预测相关。结合临床预测指标和超声测量的评分应用前景广阔。关于困难面罩通气的数据较少，超声的作用仍存在争议。需要开展进一步研究。
CRD42021250574。
