Frequency distribution of modified Cormack‐Lehane views—A retrospective audit of tracheal intubation in children with normal airways

Abstract

Funding informationDepartmental resources only. Background: Paediatric patients with an unanticipated poor grade of laryngoscopic view during tracheal intubation represent a challenging situation potentially associated with increased morbidity and mortality. The aim of this study was to investigate the frequency of modified Cormack-Lehane (MCL) views and to elucidate variables for poor views in a large collective of children without anticipated airway difficulties. Methods: The departmental anaesthesia patient database was searched for patients who had undergone general anaesthesia with tracheal intubation between January 2007 and March 2017. Inclusion criteria were age from birth to 17.99 years, general anaesthesia with tracheal intubation using direct laryngoscopy, no history, symptoms or signs of a difficult airway and the best obtained MCL view documented in the database. Patient-and anaesthesia-related variables associated with a poor view (MCL IIb, III and IV) were elucidated using a logistic regression model. Results: In all, 22 965 patients were included; of these, 17 593 were observed only once.The prevalence of the first observed MCL views I, IIa, IIb, III and IV was 90.6%, 8.5%, 0.86%, 0.05% and 0%, respectively. The logistic regression model indicates that age and gender are the most important variables associated with MCL views IIb and III in the model. The probability for MCL views IIb/III decreases across the first 5-7 years before increasing again. Conclusions:The incidence of a poor grade of laryngoscopic view was found to be very low in children with a normal airway. They mainly occurred in infants and adolescent patients and were more common in male patients. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Schmid K, Buehler PK, Schmitz A, Both CP, Weiss M. Frequency distribution of modified Cormack-Lehane views-A retrospective audit of tracheal intubation in children with normal airways. Acta Anaesthesiol Scand.

Comparison of hypoxemia, intubation procedure, and complications for non-invasive ventilation against high-flow nasal cannula oxygen therapy for patients with acute hypoxemic respiratory failure: a non-randomized retrospective analysis for effectiveness and safety (NIVaHIC-aHRF)

“…If the part of the glottis could not be visualized but the epiglottis could be visualized then it was graded as III. If neither glottis nor epiglottis could be visualized then it was graded as IV [14].…”

Paediatric anterior larynx: presentations, associations and a review of the literature

“…This is higher than what was previously reported in the literature. Schmid et al reported that M‐CL IIb/III/IV views were present in 0.91% in a retrospective case series of 17593 paediatric surgical patients undergoing orotracheal intubation at a university hospital, but with no symptoms or signs suggestive of airway compromise 2 . These authors determined, using multiple regression analysis, that age and male sex were independent predictive variables of a difficult laryngeal view.…”

“…Among them, 532 were deemed irrelevant or excluded after reviewing titles and abstract. Four articles addressed qualitatively and quantitively the topic of difficult laryngoscopy in children outside the context of Pierre Robin Sequence 2–5 …”

“…Four articles addressed qualitatively and quantitively the topic of difficult laryngoscopy in children outside the context of Pierre Robin Sequence. [2][3][4][5] A nested, retrospective, case-control study was performed at a single paediatric Otolaryngology tertiary practice (Stollery Children's Hospital, Edmonton, Alberta, Canada). The study was approved by the Health Ethics Research Board at the University of Alberta (Pro00105283).…”

“…Anterior larynx (AL) is a term often used in the literature to describe a larynx that is difficult to visualise using a standard intubation laryngoscope 1 . It is referred to whenever a grade IIb‐III or IV laryngeal view (according to the Modified Cormack‐Lehane classification–MC‐L) is encountered on direct laryngoscopy prior to intubation 2 . In grade IIb, the arytenoids only are visible, whereas in grade III only the epiglottis is visible, and in grade IV view no supraglottic structures are seen.…”