Effectiveness of simplified predictive intubation difficulty score and thyromental height in head and neck surgeries: an observational study
Eficácia do escore simplificado preditivo de dificuldade de intubação e da altura tiromentoniana em cirurgias de cabeça e pescoço: estudo observacional
Onur Selvi, Seda Tugce Kahraman, Serkan Tulgar, Ozgur Senturk, Talat Ercan Serifsoy, David Thomas, Ayse Surhan Cinar, Zeliha Ozer
Abstract
Background and objectives
In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies.
Methods
One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined.
Results
A total of 25.4% of the patients had difficult intubations. SPIDS scores > 10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT.
Conclusions
The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.
Keywords
Resumo
Resumo
Justificativa e objetivos
Neste estudo, avaliamos o valor preditivo de diferentes ferramentas de avaliação das vias aéreas, incluindo componentes do Escore Simplificado Preditivo de Intubação Difícil (ESPID), o próprio ESPID e a Medida da Altura Tireomentoniana (MATM), em intubações definidas como difícies pelo Escore de Dificuldade de Intubação (EDI) em um grupo de pacientes com patologia de cabeça e pescoço.
Método
Incluímos no estudo 153 pacientes submetidos a cirurgia de cabeça e pescoço. Coletamos os resultados do Teste de Mallampati Modificado (TMM), Distância Tireomentoniana (DTM), Razão Altura/Distância Tireomentoniana (RADTM), MATM, amplitude máxima de movimentação da cabeça e pescoço e da abertura da boca. Os ESPIDs foram calculados e os EDIs determinados.
Resultados
Observamos intubação difícil em 25,4% dos pacientes. Os escores de ESPID > 10 tiveram sensibilidade de 86,27%, especificidade de 71,57% e valor preditivo negativo de 91,2% (VPN). O resultado da análise da curva de operação do receptor (curva ROC) para os testes de avaliação das vias aéreas e ESPID mostrou que o ESPID tinha a maior área sob a curva; no entanto, foi estatisticamente semelhante a outros testes, exceto para o TMM.
Conclusões
O presente estudo demonstra o uso prático do ESPID na previsão da dificuldade de intubação em pacientes com patologia de cabeça e pescoço. O desempenho do ESPID na predição de via aérea difícil mostrou-se tão eficiente quanto os demais testes avaliados neste estudo. O ESPID pode ser considerado ferramenta abrangente e detalhada para prever via aérea difícil.
Palavras-chave
References
1 Z. Xu, W. Ma, D.L. Hester, Y. Jiang Anticipated and unanticipated difficult airway management Curr Opin Anaesthesiol., 31 (2018), pp. 96-103
2 A.K. Nørskov, C.V. Rosenstock, J. Wetterslev, et al. Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database Anaesthesia., 70 (2015), pp. 272-281
3 T.A. Iseli, C.E. Iseli, J.B. Golden, et al. Outcomes of intubation in difficult airways due to head and neck pathology Ear Nose Throat J., 91 (2012), pp. E1-E5
4 T.M. Cook, N. Woodall, C. Frerk Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia; Fourth National Audit Project Br J Anaesth., 106 (2011), pp. 617-631
5 A.K. Nørskov, C.V. Rosenstock, L.H. Lundstrøm Lack of national consensus in preoperative airway assessment Dan Med J. (2016), p. 63 pii: A5278
6 F. Etezadi, A. Ahangari, H. Shokri, et al. Thyromental height: a new clinical test for prediction of difficult laryngoscopy Anesth Analg., 117 (2013), pp. 1347-1351
7 J. L’Hermite, E. Nouvellon, P. Cuvillon, et al. The Simplified Predictive Intubation Difficulty Score: a new weighted score for difficult airway assessment Eur J Anaesthesiol., 26 (2009), pp. 1003-1009
8 A.R. El-Ganzouri, R.J. McCarthy, K.J. Tuman, et al. Preoperative airway assessment: predictive value of a multivariate risk index Anesth Analg., 82 (1996), pp. 1197-1204
9 O. Selvi, T. Kahraman, O. Senturk, et al. Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study J Clin Anesth., 36 (2017), pp. 21-26
10 J. Arné, P. Descoins, J. Fusciardi, et al. Preoperative assessment for difficult intubation in general and ENT surgery: predictive value of a clinical multivariate risk index Br J Anaesth., 80 (1998), pp. 140-146
11 I. Ahmad, O. Keane, S. Muldoon Enhancing airway assessment of patients with head and neck pathology using virtual endoscopy Indian J Anaesth., 61 (2017), pp. 782-786
12 J.L. Apfelbaum, C.A. Hagberg, R.A. Caplan, et al. A practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway Anesthesiology., 118 (2013), pp. 251-270
13 D. Roth, N.L. Pace, A. Lee, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients Cochrane Database Syst Rev., 5 (2018), p. CD008874
14 J.P. Badheka, P.M. Doshi, A.M. Vyas, et al. Comparison of upper lip bite test and ratio of height to thyromental distance with other airway assessment tests for predicting difficult endotracheal intubation Indian J Crit Care Med., 20 (2016), pp. 3-8
15 D. Shobha, M. Adiga, D.D. Rani, et al. Comparison of Upper Lip Bite Test and Ratio of Height to Thyromental Distance with Other Airway Assessment Tests for Predicting Difficult Endotracheal Intubation Anesth Essays Res., 12 (2018), pp. 124-129
16 K.V.N. Rao, D. Dhatchinamoorthi, A. Nandhakumar, et al. Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension Indian J Anaesth., 62 (2018), pp. 603-608
17 S. Bala, Bhaskar Newer airway assessment techniques: A view on their utility Indian J Anaesth., 61 (2017), pp. 779-781
18 O. Hung, J.A. Law, I. Morris, et al. Airway Assessment Before Intervention: What We Know and What We Do Anesth Analg., 122 (2016), pp. 1752-1754
19 A.K. Nørskov, J. Wetterslev, C.V. Rosenstock, et al. Effects of using the simplified airway risk index vs. usual airway assessment on unanticipated difficult tracheal intubation − a cluster randomized trial with 64,273 participants Br J Anaesth., 116 (2016), pp. 680-689
20 N. Lages, D. Vieira, J. Dias, et al. Ultrasound guided airway access Rev Bras Anestesiol., 68 (2018), pp. 624-632
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