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标题：Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway
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作者：Rishabh Agarwal ; Gaurav Jain ; Ankit Agarwal 等
期刊名称：Korean Journal of Anesthesiology
印刷版ISSN：2005-6419
出版年度：2021
卷号：74
期号：2
页码：134-141
DOI：10.4097/kja.20114
语种：English
出版社：The Korean Society of Anesthesiologists,
摘要：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.
关键词：Airway management;Diagnostic ultrasound;General anesthesia;Hyoid bone;Intubation;Laryngoscopy;Tongue