Predictive Performance of Three Multivariate Difficult Tracheal Intubation Models: A Double-Blind, Case-Control Study

Naguib, Mohamed; Ensor, Joe; O'Sullivan, Cormac T

doi:10.1213/01.ane.0000246271.63477.84

Cited by 2 publications

(3 citation statements)

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“…Furthermore, large breasts, short neck, restricted mouth opening and limitation of flexion and extension of cervical spine and atlanto-occipital joint all contribute to this situation 32 . Nevertheless, many authors 9,12,23,24 found no correlation between difficult intubation and age, sex and weight, which is in concordance to present study. Turkan et al 33 had an idea that the predictive parameters should be reconsidered in the context of age and sex.…”

Section: Discussionsupporting

confidence: 93%

“…These events included desaturation, hypertension, esophageal intubation, pharyngeal trauma, dental injury, cancellation of surgery, increased hospital stay and an increased rate of unexpected intensive care unit admission. 19 Most of the studies [20][21][22][23][24][25] used CL Grade III, IV to define difficult intubation and some used intubation difficulty scale (IDS) [26][27][28] . We described difficulty in visualisation of larynx (DVL) as CL III,IV and difficult intubation (DI) as DIS>4, described by Aftab et al 10 .…”

Section: Discussionmentioning

confidence: 99%

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Predicting Difficult Intubation in Surgical Patients Scheduled for General Anaesthesia: A Prospective Study of 435 Patients

Naithani¹,

Gupta²,

Gupta³

et al. 2013

jemds

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BACKGROUND: Unanticipated difficult tracheal intubation is a significant source of morbidity and mortality in anaesthetic practice which can be reduced by identification of potential difficult intubation. OBJECTIVE: We aimed the present study to know the incidence of difficult intubation, factors associated with it and the predictive value of various airway predictors in anticipating difficult visualization of larynx and difficult intubation. METHODS: 435 adult patients (>18 year) undergoing general anaesthesia with intubation were examined preoperatively for demographic details (age, sex, weight), dentition, airway pathology and six airway predictors i.e. Inter Incisor Gap (IIG), Modified Mallampatti Grading (MMPG), Upper lip bite test (ULBT), Thyromental distance (TMD), Sternomental distance (SMD) and subluxation of mandible (SLM). All patients were anaesthetized using standard protocol with thiopentone (5mg/kg) and succinylcholine (1.5 mg/kg). On direct laryngoscopy, Cormack Lehane (CL) grading was noted. CL grade I, II was defined as easy visualization of larynx (EVL) and CL grade III, IV as difficult visualization of larynx (DVL). Difficult intubation score (DIS) was calculated as sum of CL grade and number of intubation attempts. DIS of less than or equal to 4 was defined as easy intubation (EI) and DIS > 4 was defined as difficult intubation (DI).Sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratios(LR) and odd's ratio value for six airway predictor tests was calculated by standard formulae. RESULTS: Incidence of DVL was 12.65% (n=55) and DI was 9.65% (n=42), with no failed intubation. All airway tests had very high negative predictive value (>90%) which implicates they identify easy intubations more precisely. MMPG and ULBT were found as nearly perfect airway predictors for difficult intubation having odds ratio of .7%) respectively, along with very high sensitivity of 92.80% and 85.7% respectively. Presence of ULBT III is the best predictor of difficult intubation (+LR 21.97) and absence of MMPG III, IV is the best predictor of difficult intubation (-LR 0.091). Abnormal dentition and airway pathology also increase the risk of difficult intubation, P<0.001. CONCLUSION: We conclude that ULBT and MMPG are "nearly perfect" airway predictors and should be used routinely during pre-anesthetic visit for screening of difficult intubation.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Predicting Difficult Intubation in Surgical Patients Scheduled for General Anaesthesia: A Prospective Study of 435 Patients

Naithani¹,

Gupta²,

Gupta³

et al. 2013

jemds

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show abstract

“…The previously reported multi-factor predictive models included Naguib's new model, a predictive formula developed using logistic regression that includes thyromental distance, Mallampati score, inter-incisor gap, and height (34). While the rst two factors were also included in our algorithm, inter-incisor gap was not, despite its signi cant association with di cult intubation in the univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

A Predictive Formula for Difficult Endotracheal Intubation in the Emergency Department

Liao

Chang

et al. 2020

Preprint

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Background Current predictors for evaluating difficult endotracheal intubation had poor accessibility or sensitivity at the emergency department, so we evaluated the incidence and predictive factors, then built an easy-to-use predictive formula.Methods For the 110 patients, difficult airway was defined as Cormack & Lehane classification grade III and IV at first attempt of intubation. The univariate associations between patient characteristics and difficult endotracheal intubation were then analyzed, and the significantly associated factors were included in a multivariate binary logistic regression model then a predictive formula was generated. Generalized association plot (GAP) was used to show the relationship between each variables.Results The incidence of difficult intubation in our study was 35.5%. In the difficult airway group, significantly higher rates (p<0.05) of high body mass index (BMI); double chin; thick, short neck; Mallampati difficulty; smaller inter-incisors distance; smaller thyromental distance; and upper airway obstruction were noted. Finally, a predictive formula for difficult intubation was successfully established by the combination of four predictors: BMI (odds ratio [OR]=1.270), thyromental distance (OR=0.614), upper airway obstruction (OR=4.038), and Mallampati difficulty (OR=5.163). A cut-off score of 4 provided the best sensitivity (79.5%) and specificity (81.7%)(95% CI: 0.794 to 0.938).Conclusions Our predictive formula could be used by emergency physicians to quickly identify and carefully manage patients with potentially difficult intubation. Early expert consultation could be sought when necessary.Trial registration This 17-month (2011/11/1-2013/3/31) prospective observational study was approved by the Institutional Review Board of MacKay Memorial Hospital (11MMHISO64).

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Predictive Performance of Three Multivariate Difficult Tracheal Intubation Models: A Double-Blind, Case-Control Study

Cited by 2 publications

References 5 publications

Predicting Difficult Intubation in Surgical Patients Scheduled for General Anaesthesia: A Prospective Study of 435 Patients

Predicting Difficult Intubation in Surgical Patients Scheduled for General Anaesthesia: A Prospective Study of 435 Patients

A Predictive Formula for Difficult Endotracheal Intubation in the Emergency Department

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