Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

Nørskov, A. K.; Wetterslev, Jørn; Rosenstock, C.; Afshari, Arash; Astrup, G.; Jakobsen, Janus Christian; Thomsen, Jan; Bøttger, Morten; Ellekvist, Marguerite; Schousboe, Birgitte; Horn, Allan; Jörgensen, Bent; Lorentzen, Kristian; Madsen, Mikkel Herold; Knudsen, Jakob S.; Thisted, B; Estrup, Stine; Mieritz, Hanne Beck; Klesse, Tilo; Martinussen, H. J.; Vedel, A; Maaløe, Rikke; Bøsling, K. B.; Kirkegaard, Peter Roy Casparij; Ibáñez, C. R.; Aleksandraviciute, G.; Hansen, L.; Mantoni, Teit; Lundstrøm, Lars Hyldborg

doi:10.1093/bja/aew057

Cited by 65 publications

(45 citation statements)

References 28 publications

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“…Four additional and independent risk factors for difficult mask ventilation were assessed in intervention departments (see below). We have addressed the impact of implementing a screening tool for difficult intubation in a separate publication , this current paper exclusively addresses the issues of predicting difficult mask ventilation and combined difficulties with mask ventilation and intubation. The two publications include overlapping patients in regard to those being both mask ventilated and tracheally intubated.…”

Section: Methodsmentioning

confidence: 99%

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Prediction of difficult mask ventilation using a systematic assessment of risk factors vs. existing practice - a cluster randomised clinical trial in 94,006 patients

et al. 2016

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We compared implementation of systematic airway assessment with existing practice of airway assessment on prediction of difficult mask ventilation. Twenty-six departments were cluster-randomised to assess eleven risk factors for difficult airway management (intervention) or to continue with their existing airway assessment (control). In both groups, patients predicted as a difficult mask ventilation and/or difficult intubation were registered in the Danish Anaesthesia Database, with a notational summary of airway management. The trial's primary outcome was the respective incidence of unpredicted difficult and easy mask ventilation in the two groups. Among 94,006 patients undergoing mask ventilation, the incidence of unpredicted difficult mask ventilation in the intervention group was 0.91% and 0.88% in the control group; (OR) 0.98 (95% CI 0.66-1.44), p = 0.90. The incidence of patients predicted difficult to mask ventilate, but in fact found to be easy ('falsely predicted difficult') was 0.64% vs. 0.35% (intervention vs. control); OR 1.56 (1.01-2.42), p = 0.045. In the intervention group, 86.3% of all difficult mask ventilations were not predicted, compared with a higher proportion 91.2% in the control group, OR 0.61 (0.41-0.91), p = 0.016. The systematic intervention did not alter the overall incidence of unpredicted difficult mask ventilations, but of the patients who were found to be difficult to mask ventilate, the proportion predicted was higher in the intervention group than in the control group. However, this was at a 'cost' of increasing the number of mask ventilations falsely predicted to be difficult.

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Section: Methodsmentioning

confidence: 99%

“…A detailed statistical analysis plan for the intubation part was published before data extraction . The statistical analyses used in this paper adhere to the same principles outlined for the intubation paper . Trial reporting adheres to the ‘CONSORT statement: extension to cluster randomised trials’ .…”

Section: Methodsmentioning

confidence: 99%

Prediction of difficult mask ventilation using a systematic assessment of risk factors vs. existing practice - a cluster randomised clinical trial in 94,006 patients

et al. 2016

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“…We assessed all patients using 13 predictors for difficult airway management (Table 1) [7,8,[14][15][16][17][18][19][20]. In addition to the predefined risk factors for difficult facemask ventilation, all anaesthetists had to tick a box stating whether facemask ventilation was anticipated to be difficult or not.…”

Section: Methodsmentioning

confidence: 99%

The DIFFMASK score for predicting difficult facemask ventilation: a cohort study of 46,804 patients

Lundstrøm¹,

Rosenstock²,

Wetterslev

et al. 2019

Anaesthesia

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Summary Facemask ventilation is an essential part of airway management. Correctly predicting difficulties in facemask ventilation may reduce the risk of morbidity and mortality among patients at risk. We aimed to develop and evaluate a weighted risk score for predicting difficult facemask ventilation during anaesthesia. We analysed a cohort of 46,804 adult patients who were assessed pre‐operatively airway for 13 predictors of difficult airway management and subsequently underwent facemask ventilation during general anaesthesia. We developed the Difficult Facemask (DIFFMASK) score in two consecutive steps: first, a multivariate regression analysis was performed; and second, the regression coefficients of the adjusted regression model were converted into a clinically applicable weighted point score. The predictive accuracy of the DIFFMASK score was evaluated by assessment of receiver operating characteristic curves. The prevalence of difficult facemask ventilation was 1.06% (95%CI 0.97–1.16). Following conversion of regression coefficients into 0, 1, 2 or 3 points, the cumulated DIFFMASK score ranged from 0 to 18 points and the area under the receiver operating characteristic curve was 0.82. The Youden index indicated a sum score ≥ 5 as an optimal cut‐off value for prediction of difficult facemask ventilation giving a sensitivity of 85% and specificity of 59%. The DIFFMASK score indicated that a score of 6–10 points represents a population of patients who may require heightened attention when facemask ventilation is planned, compared with those patients who are obviously at a high‐ or low risk of difficulties. The DIFFMASK score may be useful in a clinical context but external, prospective validation is needed.

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“…Although efforts have been made to find reliable predictive tests for difficult airways [12][13][14], these tests may frequently fail to predict the difficulty.…”

Section: Adequate Planningmentioning

confidence: 99%

Progress in difficult airway management

Asai

2017

J Anesth

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Effects of using the simplified airway risk index vs usual airway assessment on unanticipated difficult tracheal intubation - a cluster randomized trial with 64,273 participants

Abstract: NCT01718561.

Cited by 65 publications

References 28 publications

Prediction of difficult mask ventilation using a systematic assessment of risk factors vs. existing practice - a cluster randomised clinical trial in 94,006 patients

Prediction of difficult mask ventilation using a systematic assessment of risk factors vs. existing practice - a cluster randomised clinical trial in 94,006 patients

The DIFFMASK score for predicting difficult facemask ventilation: a cohort study of 46,804 patients

Progress in difficult airway management

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