Role of upper airway ultrasound in airway management

Abstract

Upper airway ultrasound is a valuable, non-invasive, simple, and portable point of care ultrasound (POCUS) for evaluation of airway management even in anatomy distorted by pathology or trauma. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinician to use ultrasound in assessment of airway anatomy for difficult intubation, ETT and LMA placement and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of postextubation stridor and left double-lumen bronchial tube size, and detecting upper airway pathologies. Widespread POCUS awareness, better technological advancements, portability, and availability of ultrasound in most critical areas facilitate upper airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future.

Clinical Audit to Assess Upper Airway Ultrasound Skills in Anaesthesia Trainees

“…Various structures such as base of the tongue, epiglottis, hyoid bone, vocal cords, thyroid cartilage, cricoid cartilage, cricothyroid membrane, and oesophagus can be seen on the sono-anatomy. Developing this skill will help the anaesthetist to assess the airway for difficult intubation, confirming the placement of endotracheal tube into the trachea, predicting the appropriate size of laryngeal mask airway and endotracheal tube, identifying oesophageal intubation, and identifying the cricothyroid membrane for front of neck access [1].…”

“…Upper airway ultrasound is a skill that is yet to become universal amongst the anaesthesia community. Various studies have been performed and have shown that upper airway ultrasound is beneficial in predicting difficult laryngoscopy, predicting the size of endotracheal tube, identifying correct endotracheal and laryngeal mask airway placement, identifying the cricothyroid membrane, prediction of post-extubation stridor and evaluation of the epiglottis [1][2][3].…”

Airway ultrasound: Point of care in children—The time is now

“…Ultrasound machines have already been recognized as a highly effective tool for assessing the overall anatomy of the neck. More recently, as its technology becomes more refined, its use has been explored and expanded upon to allow for more effective assessment and evaluation of the airway . Point‐of‐care ultrasound is in fact becoming an important tool in pediatric airway diagnosis and management.…”

Comments to Role of upper airway ultrasound in airway management

“…With great interest, I read the article by Osman et al, entitled “Role of upper airway ultrasound (US) in airway management” [1]. The authors reviewed thoroughly for the various US applications for the upper airway, including prediction of endotracheal tube (ETT) size, difficult laryngoscopy, airway device placement and depth, percutaneous cricothyroidotomy, prediction of post-extubation stridor, and evaluation of the epiglottis.…”

“…The esophagus is located at the posterior area of the left lobe of the thyroid gland [1]. Tracheal intubation is identified if only one A–M interface is present with one comet-tail artifact.…”