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

Hagiwara, Yusuke; Watase, Hiroko; Okamoto, Hiroshi; Goto, Tadahiro; Hasegawa, Kohei

doi:10.1016/j.ajem.2015.06.038

Cited by 64 publications

(57 citation statements)

References 21 publications

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“…Although the impact of a difficult airway is widely recognized, there are no standardized definitions for difficult airway in the ED setting. As the definition of difficult airway varies across studies, the incidence of the difficult airway is as wide as 2% to 27% . Difficult airway is generally divided into several dimensions: (i) difficult laryngoscopy, (ii) difficult bag‐mask ventilation, (iii) difficult extraglottic devices (EGD), (iv) difficult cricothyroidotomy.…”

Section: Airway Management Algorithm and Difficult Airwaysmentioning

confidence: 99%

“…However, the original LEMON criteria included the Mallampati score; a modified LEMON criteria excluding this score has been proposed and validated externally . This modified LEMON criteria is concise, and the absence of any items in the criteria indicates the absence of difficult laryngoscopy with a high sensitivity (85.7%) and negative predictive value (98.2%) …”

Section: Airway Management Algorithm and Difficult Airwaysmentioning

confidence: 99%

“…Over the past decade, the NEAR group has also made a substantial impact on the international emergency medicine research community, including the KEAMR and JEAN groups . For example, the JEAN study is a multicenter prospective effort that is run by the Japanese Emergency Medicine Network (JEMNet) (http://jemnet.asia/wp/).…”

Section: Summary and Future Directionsmentioning

confidence: 99%

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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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Section: Airway Management Algorithm and Difficult Airwaysmentioning

confidence: 99%

Section: Airway Management Algorithm and Difficult Airwaysmentioning

confidence: 99%

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Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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“…This could be the result of the lack of PSA education and also the lack of recognition of the value of pre‐PSA systematic risk evaluation. Airway assessment, which is a key component of pre‐PSA evaluation, has been widely carried out for emergency airway management in Japanese EDs . This suggests that Japanese physicians might already have a skill set to carry out pre‐PSA evaluation but just do not routinely apply their skills for PSA.…”

Section: Discussionmentioning

confidence: 99%

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Norii

Kimura²,

Homma³

et al. 2018

Acute Medicine & Surgery

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Aim Worldwide, health‐care providers carry out procedural sedation and analgesia (PSA) in the emergency department. However, training opportunities are limited in many Asian countries, including Japan. We formed an educational group consisting of board‐certified emergency physicians in the USA and Japanese physicians and developed a PSA training module. The aims of our study were to demonstrate the effectiveness of training and to describe PSA practice in Japan. Methods We undertook a pretest of PSA knowledge questions and a retest immediately after the training intervention. We also carried out a survey and asked about participants' PSA practice. The training module consisted of four didactic hours and three simulation and skills laboratory hours. Results of all pre‐ and post‐intervention knowledge questions were analyzed with McNemar's test, and overall scores were analyzed with a paired t‐test. Results One hundred and forty‐four health‐care providers including 123 physicians, 16 nurses, two pharmacists, and three medical students participated in the training. A total of 119 (83%) completed both the pre‐ and post‐intervention knowledge questions. Before the training, participants scored an average 66% (63%–69%) on the written knowledge test. After the intervention, participants showed significant improvement on the knowledge test (improvement 17%; 14%–20%). Among participants who answered the practice survey, 121 (88%) have undertaken PSA. Only 14 (12%) participants always or often use a continuous capnography for PSA. Only 32 (26.4%) participants undertook pre‐PSA systematic evaluation. Conclusion Our educational intervention successfully increased participants' knowledge. Only the minority of health‐care providers use capnography routinely for PSA, and pre‐PSA evaluation is not commonly carried out.

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“…Zor entübasyona veya ventilasyona neden olabilecek faktörleri hızlı ve kolay tanımlamak için LEMON değerlendirmesini kullanabilirsiniz (23) . Bileşenleri, (LE) Kısa boyun, ağız açıklığı, tiromental mesafe gibi zor hava yolunun fenotipik öngördürücülerini, (M) Mallampati sınıflaması, (O) stridor duyulan üst hava yolu obstrüksiyonu ve (N) boyun hareketlerini değerlendirmektir.…”

Section: Introductionunclassified

Safely Airway Management in Larinks and Tracheobronchial Injuries

Demirgan¹,

Mingir²,

Kerem³

2017

Okmeydani Medical Journal

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ÖZ GİRİŞTravma, dünyadaki her 10 ölümün yaklaşık 1' ine neden olan önemli ve uluslararası bir sorundur(1) . Bü-yük ölçüde genç nüfusu etkiler. On beş-elli dokuz yaş grubunda, tüm ölümlerin %13-29' undan sorumludur. Travmada ölüm genellikle (%20-86) hastane öncesi ortamda meydana gelir (2) . Özellikle erken ve etkili güvenli hava yolu desteğinin, travmazedelerin yaşamda kalmasını artırabileceğine yönelik çok sayıda teorik ve niceliksel kanıt bulunmaktadır. Hastaneye varmış politravma hastalarının morbidite ve mortalitesi genellikle hava yolu yönetimindeki hatalar sonucu ortaya çıkar. Gruen ve ark.(3) hastaneye ulaştırıl-mış 2594 politravma hastasında mortaliteye katkıda bulunan hata modellerini saptamaya çalışmışlar, hava yolu güvenliğinin sağlanamaması veya korunamamasının mortaliteye ilişkin en yaygın faktör olduğunu bulmuşlardır.Günümüzde, fasiyal travmalar, trafik kazaları, endüstriyel kazalar, silah ve bıçak saldırıları, terör eylemleri ve savaş yaralanmaları nedeniyle oldukça yaygındır (4,5) . Fasiyal yaralanmalar, kafa travması ve hava yolu bütünlüğünde bozulma ile birlikte değilse genellikle yaşamı tehdit etmez. Bu tür hastalarda hava yolu güvenliği ile ilgili başlıca riskler; hastanın hava yolu anatomisinde bulunan kemiklerin parçalanması, yumuşak doku bütünlüğünün bozulması ve aspirasyon pnömonisi insidansının artmasıdır (6) . Travma yönetiminin ABC'lerinin acil serviste yapılmasını sağlamak için ciddi bir fasiyal travma ile uğraşırken multidisipliner yaklaşıma gereksinim duyulmaktadır. Amaç; hava yolu güvenliğinin sağlanması, hastanın solunumunun stabilize edilmesi, kanamanın kontrol edilmesi ve servikal vertebralarda herhangi bir hasar olmadığından emin olmaktır (7) .Supraklavikular bölgede yaralanması olan bir hastada görüntüleme ile aksi ispat edilene kadar servikal vertebra hasarı var olarak kabul edilir (8) . Bilinci yerinde olmayan veya nörolojik defisitli, anormal refleksleri Okmeydanı Tıp Dergisi 33(Ek sayı):

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

Cited by 64 publications

References 21 publications

Advancing emergency airway management practice and research

Advancing emergency airway management practice and research

A collaborative educational intervention on procedural sedation and analgesia across the Pacific

Safely Airway Management in Larinks and Tracheobronchial Injuries

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