Anushaprasath U, Kumar Mritunjay, Kamal Manoj, Bhatia Pradeep, Kaloria Narendra, Paliwal Bharat, Gupta Sunit Kumar, Mohammed Sadik, Sharma Ankur
Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2024 Jul-Sep;40(3):422-431. doi: 10.4103/joacp.joacp_181_23. Epub 2023 Oct 18.
None of the clinical difficult airway predictors are 100% sensitive and specific. Ultrasound is being used for airway assessment, but there is still no established parameters or model to predict difficult laryngoscopy. This observational study was planned to determine the predictive ability of clinical and sonography-based airway assessment parameters for difficult laryngoscopy and intubation.
A total of 130 patients of 18-60 years of age undergoing elective intubation were included. The distribution of Cormack-Lehane (CL) grade and intubation difficulty scale (IDS) was correlated with the clinical and sonographic screening parameters for difficult airways.
The prevalence of difficult laryngoscopy and difficult intubation in our study was 17.6% and 11.5%, respectively. Mallampati grade (MMG), upper lip bite test (ULBT), neck circumference, hyomental distance ratio (HMDR), tongue thickness (TT), skin to epiglottis/epiglottis to vocal cord distance (SED/E-VC), and mandibular condylar mobility (MCM) had significant association with the difficult laryngoscopy and MMG, neck circumference, SED, SED/E-VC; MCM had significant association with the difficult intubation. The combination of these predictors showed better diagnostic ability for difficult airways. Model 1 based on ultrasound parameters showed an area under the curve (AUC) of 0.848 (CI- 0.748-0.947, value < 0.0001) and model 2 based on combined clinical and ultrasound parameters showed an AUC of 0.755 (95% CI- 0.631-0.879, value < 0.0001).
Ultrasound-based airway predictors can help in predicting difficult laryngoscopy and intubation along with the clinical parameters. Individual sonographic predictors have moderately satisfactory diagnostic profiles. The models based on combined tests have better diagnostic value.
目前尚无一种临床困难气道预测指标具有100%的敏感性和特异性。超声已被用于气道评估，但仍没有既定的参数或模型来预测困难喉镜检查。本观察性研究旨在确定基于临床和超声的气道评估参数对困难喉镜检查和插管的预测能力。
共纳入130例年龄在18至60岁之间接受择期插管的患者。将Cormack-Lehane（CL）分级和插管困难量表（IDS）的分布与困难气道的临床和超声筛查参数进行相关性分析。
在我们的研究中，困难喉镜检查和困难插管的发生率分别为17.6%和11.5%。Mallampati分级（MMG）、上唇咬合试验（ULBT）、颈围、颏下距离比（HMDR）、舌厚度（TT）、皮肤至会厌/会厌至声带距离（SED/E-VC）以及下颌髁突活动度（MCM）与困难喉镜检查显著相关，而MMG、颈围、SED、SED/E-VC；MCM与困难插管显著相关。这些预测指标的组合对困难气道具有更好的诊断能力。基于超声参数的模型1曲线下面积（AUC）为0.848（CI - 0.748 - 0.947，P值<0.0001），基于临床和超声参数组合的模型2的AUC为0.755（95%CI - 0.631 - 0.879，P值<0.0001）。
基于超声的气道预测指标可与临床参数一起帮助预测困难喉镜检查和插管。各个超声预测指标具有中等程度的满意诊断特征。基于联合检测的模型具有更好的诊断价值。
