Determination of difficult intubation in the ED

Söyüncü, Seçgin; Eken, Cenker; Çete, Yıldıray; Bektaş, Fırat; Akçimen, Mehmet

doi:10.1016/j.ajem.2008.07.003

Cited by 49 publications

(50 citation statements)

References 9 publications

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“…However, the measurement of Mallampati score is both difficult to assess (or not feasible) and a poor predictor in the ED setting [3]. In this context, in another singlecenter study in Turkey (n = 366), Soyuncu et al [1] reported that the modified LEMON criteria are associated with a higher risk of difficult intubation as defined by multiple intubation attempts-similar to the definition of our study. However, neither study reported more practical indicator of performance-that is, sensitivity, specificity, and predictive values of the prediction rule.…”

Section: Discussionsupporting

confidence: 76%

“…systems [1,3]. These data collectively lend a significant support to the use of modified LEMON criteria in EDs.…”

supporting

confidence: 55%

“…After each intubation, the operator completed a standard data collection form that included the patient demographics (age, sex, body mass index), primary indication for intubation, components of the modified LEMON criteria [1,3], Mallampati score, methods of intubation, devices, medications, operator level of training and specialty, CormackLehane grade, success and failure at each attempt, and intubationrelated complications. The modified LEMON criteria consisted of (1) external looking, (2) distance between the incisor teeth, (3) distance between the hyoid bone and the chin, (4) airway obstruction, and (5) neck immobility.…”

Section: Data Collection and Processingmentioning

confidence: 99%

“…By contrast, in the ED setting, the evidence to predict difficult airways remains scarce. Two small studies (n b 370) created prediction rules of difficult intubation in the ED (eg, the modified LEMON criteria) [1,3]. However, these studies were conducted within limited populations (eg, single-center study), thereby limiting generalizability of their inferences.…”

Section: Introductionmentioning

confidence: 99%

“…Emergency intubations are more difficult than elective intubations in the operation room setting because of the sicker patient population with a limited physiologic reserve and less controlled setting in the ED [1]. Indeed, the proportion of difficult intubation ranges from 10% to 27% in the ED setting [2][3][4][5], whereas the rate ranges from 1% to 9% of elective intubation in the anesthesia setting [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Hagiwara

Watase

Okamoto

et al. 2015

The American Journal of Emergency Medicine

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Section: Discussionsupporting

confidence: 76%

“…systems [1,3]. These data collectively lend a significant support to the use of modified LEMON criteria in EDs.…”

supporting

confidence: 55%

Section: Data Collection and Processingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Hagiwara

Watase

Okamoto

et al. 2015

The American Journal of Emergency Medicine

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Airway physical examination tests for detection of difficult airway management in apparently normal adult patients

Roth

Pace

Lee

et al. 2018

Cochrane Database of Systematic Reviews

157

146

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BackgroundThe unanticipated di icult airway is a potentially life-threatening event during anaesthesia or acute conditions. An unsuccessfully managed upper airway is associated with serious morbidity and mortality. Several bedside screening tests are used in clinical practice to identify those at high risk of di icult airway. Their accuracy and benefit however, remains unclear. ObjectivesThe objective of this review was to characterize and compare the diagnostic accuracy of the Mallampati classification and other commonly used airway examination tests for assessing the physical status of the airway in adult patients with no apparent anatomical airway abnormalities. We performed this individually for each of the four descriptors of the di icult airway: di icult face mask ventilation, di icult laryngoscopy, di icult tracheal intubation, and failed intubation. Search methodsWe searched major electronic databases including CENTRAL, MEDLINE, Embase, ISI Web of Science, CINAHL, as well as regional, subject specific, and dissertation and theses databases from inception to 16 December 2016, without language restrictions. In addition, we searched the Science Citation Index and checked the references of all the relevant studies. We also handsearched selected journals, conference proceedings, and relevant guidelines. We updated this search in March 2018, but we have not yet incorporated these results. Selection criteriaWe considered full-text diagnostic test accuracy studies of any individual index test, or a combination of tests, against a reference standard. Participants were adults without obvious airway abnormalities, who were having laryngoscopy performed with a standard laryngoscope and the trachea intubated with a standard tracheal tube. Index tests included the Mallampati test, modified Mallampati test, Wilson risk score, thyromental distance, sternomental distance, mouth opening test, upper lip bite test, or any combination of these. The target condition was di icult airway, with one of the following reference standards: di icult face mask ventilation, di icult laryngoscopy, di icult tracheal intubation, and failed intubation. Airway physical examination tests for detection of di icult airway management in apparently normal adult patients (Review)

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Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.

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Determination of difficult intubation in the ED

Cited by 49 publications

References 9 publications

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Prospective validation of the modified LEMON criteria to predict difficult intubation in the ED

Airway physical examination tests for detection of difficult airway management in apparently normal adult patients

Advancing emergency airway management practice and research

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