Validity of airway predictors in outpatient medicine
DOI:
https://doi.org/10.23938/ASSN.0358Keywords:
Orotraqueal intubation. Difficult airway. Emergency medical services.Abstract
Isolation of the airway sometimes determines the survival or death of the patient. To anticipate the presence of a difficult airway (DA) there are a number of indicators that are validated for hospitals: Mallampati, sternum and thyromental distance, interdental distance and Cormack grade. The aim of this study is to evaluate the use of these indicators in the ambulatory setting and to know the incidence of DA. This data was collected from 324 intubations. Most patients were males (65.2%). The average age of the population was 63 years and no significant difference in age between DA and DA was found. A DA presence of 20.7% was objectified and an alternative device utilization of 21.4%. The thyromental distance was abnormal in 59% of patients and sternomentonal distance in 56.4% but neither showed an association with the presence of DA (p = 0.681 and p = 0.415 respectively). Interdental distance was less than 3 cm if presence is associated with DA (p = 0.005). The sensitivity and specificity of all measures are low. According to our series the sternum and thyromental distance are not useful in the ambulatory setting, but interdental distance is useful for predicting a DA.Downloads
References
1. SALINAS MARTÍN MP, LÓPEZ CALER C, VALERO ROLDÁN JI, DEL PRADO MARTÍNEZ MF, GARCÍA QUESADA G. Factores que influyen en la mortalidad de los pacientes ingresados por traumatismo craneoencefálico en un servicio de cuidados críticos y urgencias. Emergencias 2013; 25: 336-337.
2. MAYOL BARRERA S, GRIMA CERVANTES O, BERBEL CASTRO J. Optimización de la reanimación cardiopulmonar mediante la utilización de la aplicación informática iRCP. Emergencias 2013; 25: 340-345.
3. BERNUMOF JL. Definition and incidence of the difficult airway. Benumof JL. Airway Management. Principles and practice. San Luis: Mosby. 1996: 126-142.
4. JON SMALLY A, ANTHONY NOWICKI T. Manejo de la vía área difícil. Emergencias 2011; 23: 479-485.
5. Castañeda Pascual M. Laringoscopio óptico Airtraq. An Sist Sanit Navar 2009; 32: 45-47.
https://doi.org/10.4321/S1137-66272009000100008
6. PARRILLA RUIZ EI, AGUILAR CRUZ I, CÁRDENAS CRUZ D, LÓPEZ PÉREZ L, CÁRDENAS CRUZ MD. Secuencia de intubación rápida. Emergencias 2012; 24: 397-399.
7. JON SMALLY A, ANTHONY NOWICKI T. Manejo de la vía área difícil. Emergencias 2011; 23: 479-485.
8. WANG HE, KUPAS DE, PARIS PM, BATES RR, CONSTATINO JP, YEALY DM. Multivariate predictors of failed prehospital endotracheal intubatio. Acad Emerg Med 2003; 10: 724.
https://doi.org/10.1197/aemj.10.7.717
9. BULGER EM, COPASS MK, MAIER RV, LARSEN J, KNOWELS J, JURKOVICH GJ. An analisis of advanced prehospital airway management. J Emerg Med 2002; 2: 183-189.
https://doi.org/10.1016/S0736-4679(02)00490-0
10. SLAGT C, ZONDERVAN A, PATKA P, DE LANGE JJ. A retrospective análisis of the intubations performed during 5 years of helicopter emergency medical service in Amsterdam. Air Med J 2004; 23: 36-37.
https://doi.org/10.1016/j.amj.2004.06.004
11. CAMACHO LEIS C, ALMAGRO GONZÁLEZ V, DE ELÍAS HERNÁNDEZ R, ESQUILAS SÁNCHEZ O, MORENO MARTÍN JL, MUÑOZ HERMOSA EJ et al. El control de la calidad en las compresiones torácicas y su relación con la recuperación de pulso. Emergencias 2013; 25: 99-104.
12. MONTMANY VIOQUE S, NAVARRO SOTO S, REBASA CLADERA P, LUNA AUFROY A, GÓMEZ DÍAZ C, LLAQUET BAYO H. Aplicación de la revisión terciaria en el manejo inicial del paciente politraumatizado. Emergencias 2013; 25: 105-110.
13. MALLAMPATI SR, GATT SP, GUGINO LD, DESAI SP, WAROKA B, FREIBERG D et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429-434.
https://doi.org/10.1007/BF03011357
14. SAMSOON GL, YOUNG JR. Difficult tracheal intubation: a retrospective study. Anesthesia 1987; 42: 487-490.
https://doi.org/10.1111/j.1365-2044.1987.tb04039.x
15. COHEN SM, LAURITO CE, SEGIL LJ. Oral examination to predict difficult intubation: a large prospective study. Anaesthesiology 1989; 71: A937.
https://doi.org/10.1097/00000542-198909001-00937
16. POTTECHER T, VELTEN M, GALANI M, FORRER M. Valeur comparee des signes cliniques 'intubation difficile chez la femme. Ann Fr Anaesth Reanim 1991; 10: 430-435.
https://doi.org/10.1016/S0750-7658(05)80845-7
17. GUILLAUMÉE F, FANTON L, DUBIEN PY, MALICIER D, PETIT P. Approach to airway control in the 5 emergency services in Lyon. Ann Fr Anesth Reanim 1997; 16: fi26.
18. SAVVA D. Prediction of difficult tracheal intubation. Br J Anaesth 1993; 71: 333-334.
https://doi.org/10.1093/bja/71.3.333
19. KAMIUTSURI K, OKUTANI R, KOZAWA S. Analysis of prehospital endotracheal intubation performed by emergency physicians: retrospective survey of a single emergency medical center in Japan. J Anesth 2013; 27: 374-379.
https://doi.org/10.1007/s00540-012-1528-x
20. KATZENELL U, LIPSKY AM, ABRAMOVICH A, HUBERMAN D, SERGEEV I, DECKEL A, KREISS Y, GLASSBERG E. Prehospital intubation success rates among Israel Defense Forces providers: epidemiologic analysis and effect on doctrine. J Trauma Acute Care Surg 2013; 75 (2 Suppl 2): S178-183.
https://doi.org/10.1097/TA.0b013e318299d650
21. NEYRINCK A. Management of the anticipated and unanticipated difficult airway in anesthesia outside the operating room. Curr Opin Anaesthesiol 2013; 26: 481-488.
https://doi.org/10.1097/ACO.0b013e328362cc69
22. APFELBAUM JL, HAGBERG CA, CAPLAN RA, BLITT CD, CONNIS RT, NICKINOVICH DG et al. American Society of Anesthesiologists Task Force on management of the difficult airway. 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 2013; 118: 251-270.
https://doi.org/10.1097/ALN.0b013e31827773b2
23. ONO K, GOTO T, NAKAI D, UEKI S, TAKENAKA S, MORIYA T. Incidence and predictors of difficult nasotracheal intubation with airway scope. J Anesth 2014; 1: 120-126.
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