Role of Ultrasound in Airway Assessment and Management

Kajekar, P.; Mendonca, Cyprian; Gaur, Vandana

doi:10.5005/jp-journals-10014-1015

Cited by 28 publications

(9 citation statements)

References 35 publications

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“…US is used in various aspects of airway management and for many purposes, such as the prediction of pediatric ETT size, confirmation of correct placement of ETT, guidance of percutaneous tracheostomy and cricothyroidotomy, and confirmation of proper laryngeal mask airway position [ 35 , 36 ]. In addition, US has been proposed to also measure some indicators that reflect the intubation-related anatomy directly or indirectly.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis

et al. 2021

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Background Ultrasonography (US) is recently used frequently as a tool for airway assessment prior to intubation (endotracheal tube (ETT) placement), and several indicators have been proposed in studies with different reported performances in this regard. This systematic review and meta-analysis reviewed the performance of US in difficult airway assessment. Methods This systematic review and meta-analysis was conducted according to the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane book. All the studies that had carried out difficult airway assessments using US, had compared the indicators in difficult and easy groups, and had published the results in English by the time we conducted our search in April 28, 2020, were included. Results In the initial search, 17,156 articles were retrieved. After deleting the duplicate articles retrieved from multiple databases, 7578 articles remained for screening based on the abstracts and titles. Finally, the full text of 371 articles were assessed and the data from 26 articles were extracted, which had examined a total of 45 US indicators for predicting difficult intubation. The most common US index was the “thickness of anterior neck soft tissue at the vocal cords level”. Also, “skin to epiglottis” and “anterior neck soft tissue at the hyoid bone level” were among the most common indicators examined in this area. Conclusion This systematic review showed that US can be used for predicting difficult airway. Of note, “skin thickness at the epiglottis and hyoid levels”, “the hyomental distance”, and “the hyomental distance ratio” were correlated with difficult laryngoscopy in the meta-analysis. Many other indicators, including some ratios, have also been proposed for accurately predicting difficult intubation, although there have been no external validation studies on them.

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Section: Discussionmentioning

confidence: 99%

Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis

et al. 2021

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“…Imaging of the airway is a newer application of ultrasound. [91112] It can be used for prediction of paediatric ETT size,[13] prediction of double lumen tube size,[14] confirmation of correct placement of ETT,[12] diagnosis of upper airway pathology,[9] guidance of percutaneous tracheostomy[9] and cricothyroidotomy,[12] for performing nerve blocks to facilitate awake intubation,[15] in the detection of subglottic stenosis,[9] prediction of post-extubation stridor[16] and confirmation of proper laryngeal mask airway position. [9]…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography - A viable tool for airway assessment

2016

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Background and Aims:Accurate prediction of the Cormack-Lehane (CL) grade preoperatively can help in better airway management of the patient during induction of anaesthesia. Our aim was to determine the utility of ultrasonography in predicting CL grade.Methods:We studied 100 patients undergoing general endotracheal anaesthesia. Mallampati (MP) class, thyromental distance (TMD) and sternomental distance (SMD) were noted. Ultrasound measurements of the anterior neck soft tissue thickness at the level of the hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of the vocal cords (ANS-VC) and ratio of the depth of the pre-epiglottic space (Pre-E) to the distance from the epiglottis to the mid-point of the distance between the vocal cords (E-VC) were obtained. CL grade was noted during intubation. Chi-square test was employed to determine if there was any statistical difference in the measurements of patients with different CL grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for the various parameters.Results:The incidence of difficult intubation was 14%. An ANS-VC >0.23 cm had a sensitivity of 85.7% in predicting a CL Grade of 3 or 4, which was higher than that of MP class, TMD and SMD. However, the specificity, PPV and accuracy were lower than the physical parameters. The NPV was comparable.Conclusion:Ultrasound is a useful tool in airway assessment. ANS-VC >0.23 cm is a potential predictor of difficult intubation. ANS-Hyoid is not indicative of difficult intubation. The ratio Pre-E/E-VC has a low to moderate predictive value.

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“…Also, it could be related to demographics of the groups and anthropometric differences among different populations and different races. Kajekar et al [17] postulated the difference between observations is due to the difference in the fat distribution between ethnic groups . This postulation was supported by previous studies using magnetic resonance imaging to prove that [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography versus conventional methods (Mallampati score and thyromental distance) for prediction of difficult airway in adult patients

Abdelhady

Elrabiey

El-Rahman

et al. 2020

Egyptian Journal of Anaesthesia

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Background: The poor reliability of traditional screening tools to identify a potentially difficult airway makes the difficult laryngoscopy and tracheal intubation rate remains at 1.5-13%.The hypothesis is that fat pads affect the view during direct laryngoscopy so the increasing thickness of pretracheal soft tissue or pre-epiglottic space could be strong predictors of difficult laryngoscopy as the mobility of the pharyngeal structures is impaired. Upon that, we aimed to evaluate ultrasound-measured distance from skin to epiglottis for prediction of difficult laryngoscopy in Egyptian population. Methods: This was a prospective single blind randomized clinical study conducted on 80 patients requiring general anesthesia.Preoperatively, airway evaluation was performed using three parameters including Mallampati score, thyromental distance and ultrasound-measured distance from skin to epiglottis at the level of thyrohyoid membrane. The primary outcome was to correlate ultrasound measured distance from skin to epiglottis with difficult laryngoscopy in Egyptian population using Cormack -Lehane grading. Results: Difficult laryngoscopy group displayed greater thickness of the ultrasound measured distance from the skin to epiglottis(2 ± 0.3 cm versus 1.7 ± 0.3 cm; p = 0.002). The cut-off point for difficult laryngoscopy was >1.85 cm with sensitivity of 80%, specificity of 70.8% and area under the receiver operating characteristic curve was 0.759. Mallampati score and thyromental distance had poor area under the curve = (0.651, 0.670 respectively). Conclusion:Our study revealed good correlation between ultrasonograohic measurement of the skin to epiglottis distance and Cormack-Lehane grade in Egyptian population, therefore it might be considered as a predictor of difficult laryngoscopy.Clinical trial number: NCT03799055.

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Role of Ultrasound in Airway Assessment and Management

Cited by 28 publications

References 35 publications

Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis

Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis

Ultrasonography - A viable tool for airway assessment

Ultrasonography versus conventional methods (Mallampati score and thyromental distance) for prediction of difficult airway in adult patients

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