Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway
Background Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultraso...
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2021-04-01
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| Series: | Korean Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://ekja.org/upload/pdf/kja-20114.pdf |
| _version_ | 1818657825052688384 |
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| author | Rishabh Agarwal Gaurav Jain Ankit Agarwal Nishith Govil |
| author_facet | Rishabh Agarwal Gaurav Jain Ankit Agarwal Nishith Govil |
| author_sort | Rishabh Agarwal |
| collection | DOAJ |
| description | Background Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated. Methods This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported. Results Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity: 84.5%, specificity: 78.1%, AUC: 0.880), > 1.4 cm (sensitivity: 81%, specificity: 85.2%, AUC: 0.898) and > 2.4 cm (sensitivity: 75.9%, specificity: 85.2%, AUC: 0.885) respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC: 0.790). The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models. Conclusions SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value. |
| first_indexed | 2024-12-17T03:47:38Z |
| format | Article |
| id | doaj.art-7502cca569cd4aa0ae0a0147cc643e59 |
| institution | Directory Open Access Journal |
| issn | 2005-6419 2005-7563 |
| language | English |
| last_indexed | 2024-12-17T03:47:38Z |
| publishDate | 2021-04-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj.art-7502cca569cd4aa0ae0a0147cc643e592022-12-21T22:04:51ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632021-04-0174213414110.4097/kja.201148658Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airwayRishabh Agarwal0Gaurav JainAnkit Agarwal1Nishith Govil2 Department of Anesthesiology, All India Institute of Medical Sciences, Rishikesh, India Department of Anesthesiology, All India Institute of Medical Sciences, Rishikesh, India Department of Anesthesiology, All India Institute of Medical Sciences, Rishikesh, IndiaBackground Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated. Methods This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported. Results Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity: 84.5%, specificity: 78.1%, AUC: 0.880), > 1.4 cm (sensitivity: 81%, specificity: 85.2%, AUC: 0.898) and > 2.4 cm (sensitivity: 75.9%, specificity: 85.2%, AUC: 0.885) respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC: 0.790). The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models. Conclusions SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value.http://ekja.org/upload/pdf/kja-20114.pdfairway managementdiagnostic ultrasoundgeneral anesthesiahyoid boneintubationlaryngoscopytongue |
| spellingShingle | Rishabh Agarwal Gaurav Jain Ankit Agarwal Nishith Govil Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway Korean Journal of Anesthesiology airway management diagnostic ultrasound general anesthesia hyoid bone intubation laryngoscopy tongue |
| title | Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway |
| title_full | Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway |
| title_fullStr | Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway |
| title_full_unstemmed | Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway |
| title_short | Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway |
| title_sort | effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway |
| topic | airway management diagnostic ultrasound general anesthesia hyoid bone intubation laryngoscopy tongue |
| url | http://ekja.org/upload/pdf/kja-20114.pdf |
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