Effectiveness and validity of midsagittal tongue cross-sectional area and width measured by ultrasound to predict difficult airways

Zheng, Zhenwei; Ma, Wuhua; Du, Ruiming

doi:10.23736/s0375-9393.20.14769-2

Cited by 8 publications

(13 citation statements)

References 22 publications

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“…After the selection process, 31 studies were included in this systematic review: all were observational studies, 30 were prospective observational studies and one had a retrospective design (Supplement 2, http://links.lww.com/EJA/A799). 9,12,22–50 …”

Section: Resultsmentioning

confidence: 99%

“…A total of 30 out of the 31 studies reported data on the prediction of difficult laryngoscopy or difficult intubation: the terms ‘difficult laryngoscopy’ and ‘difficult intubation’ were used as synonyms in almost all the articles and were assessed with the Cormack-Lehane classification. In four studies, difficult intubation was specifically evaluated with different tools: in two cases, it was measured with the Intubation Difficulty Scale, in two others, it was defined as ‘…an insertion of the tracheal tube using conventional laryngoscopy that required more than two attempts, lasted >10 min, or required an alternative technique’ 24,32,35,41,50,51 …”

Section: Resultsmentioning

confidence: 99%

“…In some studies, obese and morbidly obese patients were defined as specific subgroups, 12,39,43,44,46,48 but in other studies obesity was considered as an exclusion criterion. 28,29,33,37,42,50 Most studies did not describe the head and neck position used for intubation: 10 reported the use of the sniffing position, 12,23,24,32,36,38,39,41,44,45 and two studies described the use of the ramped position for obese patients. 39,43 The use of external laryngeal manipulation was not permitted in seven studies, 34,[36][37][38]40,44,45 while it was allowed in others.…”

Section: Resultsmentioning

confidence: 99%

“…Alessandri et al 2019 9 Falcetta et al 2018 22 Bianchini et al 2021 23 Zheng et al 2021 24 Adhikari et al 2011 25 Gupta et al 2012 26 Hui et al 2014 27 Pinto et al 2016 28 Soltani et al 2016 29 Andruszkiewicz et al 2016 30 Reddy et al 2016 31 Yao et al 2017 32 Parameswari et al 2017 33 Rana et al 2018 34 Wang et al 2019 35 Yadav et al 2019 36 Koundal et al 2019 37 Martinez-Garcia et al 2021 38 Petrisor et al 2020 39 Ni et al 2020 40 Agarwal et al 2021 41 Altun et al 2021 42 Petrisor et al 2018 43 Dagguppati et al 2020 44 Ezri et al 2003 12 Komatsu et al 2007 45 Kalezic et al 2016 47 Wojtczak et al 2012 48 Wu et al 2014 49…”

Section: Meco Et Al 2015 50mentioning

confidence: 99%

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Pre-operative ultrasound prediction of difficult airway management in adult patients

Giordano

Alessandri

Zulian

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPredicting 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.OBJECTIVESThe 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.DESIGNA systematic review of randomised controlled trials and observational studies.DATA SOURCESThe MEDLINE, EMBASE and Google Scholar databases were queried from inception until 28 February 2022.ELIGIBILITY CRITERIAStudies 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.RESULTSThirty-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.CONCLUSIONSThe 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.CLINICAL TRIAL REGISTRATIONCRD42021250574.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Meco Et Al 2015 50mentioning

confidence: 99%

See 2 more Smart Citations

Pre-operative ultrasound prediction of difficult airway management in adult patients

Giordano

Alessandri

Zulian

et al. 2023

European Journal of Anaesthesiology

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“…Ultrasound training and experience were not defined in multiple studies (6, 13, 13, 14, 18, 21, 23–28, 31–33, 35–39). Ultrasound was performed by clinicians with quantifiable experience in three studies (15, 19, 20), and the remaining studies only described the sonographers as having received training or experience (7, 13, 16, 17, 22, 29, 30, 34, 40–42). Two studies performed the ultrasound airway assessment postoperatively (16, 18).…”

Section: Resultsmentioning

confidence: 99%

Prediction of Difficult Laryngoscopy Using Ultrasound: A Systematic Review and Meta-Analysis

Bhargava

Rockwell

Tawfik

et al. 2022

Critical Care Medicine

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OBJECTIVES: Evaluate associations between ultrasound measures and difficult laryngoscopy. DATA SOURCES: MEDLINE, Embase, Google Scholar, Web of Science, and the Cochrane Library were searched using MeSH terms and keywords. STUDY SELECTION: Studies published in English describing the use of airway ultrasound for identifying difficult laryngoscopy, with sufficient data to calculate sensitivity and specificity using 2 × 2 tables. DATA EXTRACTION: We assigned the described indices of airway dimension to one of three domains based on methodology characteristics: anterior tissue thickness domain, anatomical position domain, and oral space domain. We then performed a bivariate random-effects meta-analysis, deriving pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio estimates. We assessed risks of bias using Quality Assessment of Diagnostic Accuracy Studies-2 analysis. DATA SYNTHESIS: Thirty-three studies evaluating 27 unique indices were included in the meta-analysis. The ultrasound protocols of the included studies were heterogeneous. Anterior tissue thickness demonstrated a pooled sensitivity of 76% (95% CI, 71–81%), specificity of 77% (95% CI, 72–81%), and an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.80–0.86). Anatomical position demonstrated a pooled sensitivity of 74% (95% CI, 61–84%), specificity of 86% (95% CI, 78–91%), and an AUROC of 0.87 (95% CI, 0.84–0.90). Oral space demonstrated a pooled sensitivity of 53% (95% CI, 0.36–0.69), specificity of 77% (95% CI, 0.67–0.85), and an AUROC of 0.73 (95% CI, 0.69–0.77). CONCLUSIONS: Airway ultrasound metrics associate with difficult laryngoscopy in three domains: anterior tissue thickness, anatomic position, and oral space. An assessment instrument combining clinical and ultrasound assessments may be an accurate screening tool for difficult laryngoscopy.

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Effectiveness of ultrasonic measurement for the hyomental distance and distance from skin to epiglottis in predicting difficult laryngoscopy in children

Zheng

Wang

et al. 2023

Eur Radiol

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Objectives Studies have shown that some ultrasonic indicators can predict difficult airways in adults to an extent. However, whether ultrasonic parameters can be used to predict difficult airways in children is unclear. This study investigated the predictive value of several ultrasonic indices for difficult laryngoscopy (DL) in children. Methods Pediatric patients aged 5 to 12 years who underwent endotracheal intubation under general anesthesia were enrolled. The hyomental distance in the extended position (HMDE), tongue thickness, midsagittal tongue cross-sectional area, tongue width, and distance from skin to epiglottis (DSE) were measured by ultrasound before anesthesia. The study end point was DL. The receiver operating characteristic curve was used to evaluate the predictive value of each parameter. Results Three hundred and ten children were included in the final analysis, and fifteen (4.8%) children had DL. The shortened HMDE assessed by ultrasound could help identify children aged 5 to 12 years with DL (5–8 years: area under the curve (AUC) 0.74, sensitivity 0.88, specificity 0.60; 9–12 years: AUC 0.72, sensitivity 0.71, specificity 0.83). An increased DSE could help identify children aged 5 to 8 years with DL (AUC 0.76, sensitivity 0.88, specificity 0.69). Conclusions Ultrasonic measurement of the HMDE can be used to predict DL in children aged 5 to 12 years. The DSE measured by ultrasound can be used to predict DL in children aged 5 to 8 years. Clinical relevance statement The hyomental distance and the distance from skin to epiglottis measured by ultrasound can be used to predict difficult laryngoscopy in children, which can help reduce serious complications caused by unanticipated difficult airways in children during anesthesia. Key Points • Ultrasonic measurement of the hyomental distance in the extended position may be an effective predictor of difficult laryngoscopy in children aged 5 to 12 years. • The distance from skin to epiglottis measured by ultrasound can be used to predict difficult laryngoscopy in children aged 5 to 8 years. • Preoperative airway assessment using ultrasound can be effectively applied in children and has a great application prospect.

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Effectiveness and validity of midsagittal tongue cross-sectional area and width measured by ultrasound to predict difficult airways

Cited by 8 publications

References 22 publications

Pre-operative ultrasound prediction of difficult airway management in adult patients

Pre-operative ultrasound prediction of difficult airway management in adult patients

Prediction of Difficult Laryngoscopy Using Ultrasound: A Systematic Review and Meta-Analysis

Effectiveness of ultrasonic measurement for the hyomental distance and distance from skin to epiglottis in predicting difficult laryngoscopy in children

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