Prediction of difficult laryngoscopy / difficult intubation cases using upper airway ultrasound measurements in emergency department: a prospective observational study

Prediction of difficult laryngoscopy / difficult intubation cases using upper airway ultrasound measurements in emergency department: a prospective observational study

Airway Management, Intubation, Intratracheal, Laryngoscopy, Ultrasonography

Introduction Difficult laryngoscopy and intubation are serious problems among critically ill patients in emergency
department (ED) so utility of a rapid, accurate and noninvasive method for predicting of these patients are necessary.
Ultrasonography has been recently used in this regard and this study was conducted to investigate the correlation
of some introduced upper airway ultrasound parameters with difficult laryngoscopy / difficult intubation in patients
referred to the ED.
Method In this prospective observational study all patients≥18-year-old who had an indication for rapid sequence
intubation (RSI) were included. Ultrasound parameters including Hyoid Bone Visibility (HBV), Distance from Skin
to Hyoid Bone (DSHB), Distance from Skin to Vocal Cords (DSVC), Distance from Skin to Thyroid Isthmus (DSTI),
and Distance between Arytenoids Cartilages (DBAC) were measured in all cases. The patients underwent RSI
and thereafter the patients’ baseline characteristics, Cormack-Lehane grade, number of attempted laryngoscopy
were recorded in a pre-prepared check list and compared with measured ultrasound parameters. The “difficult
laryngoscopy” was defined as Cormack-Lehane classification grades III/IV; and need for more than 3 intubation
attempts was considered as “difficult intubation”.
Results One hundred and twenty-three patients (52% male) were included of whom 10 patients (8.1%) were
categorized as difficult laryngoscopy cases; and just 4 (3.3%) cases underwent more than 3 laryngoscopy attempts
who considered as difficult intubation cases. The mean age of the patients in non-difficult and difficult intubation
groups were 69.2±15.16 and 68.77±17.37 years, respectively (p>0.05). There was no significant relationship between
difficult laryngoscopy and HBV (p=0.381) but has significant correlation with difficult intubation (p=0.004). The DSHB
had a significant correlation with difficult laryngoscopy (p=0.002) but its correlation with difficult intubation was not

Mehran Sotoodehnia , Maryam Khodayar , Alireza Jalali , Mehdi Momeni , Arash Safaie and Atefeh Abdollahi

dmc

2023

Fajar bagus W

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