Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis
Dublin Core
Title
Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis
Subject
Airway management, Difficult airway, Intratracheal intubation, Prediction, Ultrasonography
Description
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
(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
Creator
Mehran Sotoodehnia , Hosein Rafiemanesh , Hadi Mirfazaelian , Arash Safaie and Alireza Baratloo
Publisher
BMC Emergency Medicine
Date
(2021) 21:76
Contributor
Fajar bagus W
Format
PDF
Language
Indonesia
Type
Text
Files
Collection
Citation
Mehran Sotoodehnia , Hosein Rafiemanesh , Hadi Mirfazaelian , Arash Safaie and Alireza Baratloo, “Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis,” Repository Horizon University Indonesia, accessed April 26, 2025, https://repository.horizon.ac.id/items/show/3869.