scholarly journals Ultrasonography indicators for predicting difficult intubation: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mehran Sotoodehnia ◽  
Hosein Rafiemanesh ◽  
Hadi Mirfazaelian ◽  
Arash Safaie ◽  
Alireza Baratloo

Abstract 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.

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Liuting Zeng ◽  
Ganpeng Yu ◽  
Yang Wu ◽  
Wensa Hao ◽  
Hua Chen

Background. Patients with psoriasis need long-term medication to control their condition. Recent studies suggest that changing the intestinal flora may be a potential treatment. Methods. The databases were utilized to search the randomized controlled trials (RCTs) and preclinical trials about probiotic supplement in the treatment of psoriasis. The retrieval time is from the establishment of these databases to December 2020. RevMan5.3 was used for the risk assessment of bias and meta-analysis. This systematic review was registered in PROSPERO (CRD42021232756). Results. A total of 3 RCTs involving 164 participants were included. Two RCTs showed that probiotics can improve PASI and thereby improve the condition. For inflammation-related indicators, only one RCT showed that probiotics can improve the levels of CRP and TNF-α but have no obvious improvement effect on IL6. One RCT demonstrated the total effective rate of probiotics in the treatment of psoriasis. For adverse events, one RCT showed that the incidence of adverse events of probiotic treatment was low. Preclinical studies showed that continuous intervention with oral probiotics can significantly improve the progression of psoriasis and reduce the expression of inflammatory factors. The meta-analysis showed that the PASI between two groups was of no statistical significance (SMD 1.83 [-0.41, 4.07], P = 0.11 ). Meanwhile, probiotics may improve skin thickness (SMD -5.87 [-11.34, -0.41], P = 0.04 ) in animal model. Conclusion. Prebiotics may have a positive effect on alleviating the clinical symptoms of psoriasis, but a large sample of RCTs is still needed to support its therapeutic effect in psoriasis.


Oncotarget ◽  
2017 ◽  
Vol 9 (20) ◽  
pp. 15365-15374 ◽  
Author(s):  
Zheng-Tao Lv ◽  
Shu-Tao Gao ◽  
Peng Cheng ◽  
Shuang Liang ◽  
Si-Yi Yu ◽  
...  

2021 ◽  
Author(s):  
Sorravit Savatmongkorngul ◽  
Panrikan Pitakwong ◽  
Pungkava Srichar ◽  
Chaiyaporn Yuksen ◽  
Chetsadakon Jenpanitpong ◽  
...  

Abstract Objective: Difficult intubation is associated with an increasing number of endotracheal intubation attempts. Repeated endotracheal intubation attempts are in turn associated with an increased risk of adverse events. Clinical prediction tools to predict difficult airway have limited application in emergency airway situations. This study was performed to develop a new model for predicting difficult intubation in the emergency department.Methods: This retrospective study was conducted using an exploratory model at the Emergency Medicine of Ramathibodi Hospital, a university-affiliated super-tertiary care hospital in Bangkok, Thailand. The study was conducted from June 2018 to July 2020. The inclusion criteria were an age of ≥15 years and treatment by emergency intubation in the emergency department. Difficult intubation was defined as a Cormack–Lehane grade III or IV laryngoscopic view. The predictive model and prediction score for detecting difficult intubation were developed by multivariable regression analysis.Results: During the study period, 617 patients met the inclusion criteria; of these, 83 (13.45%) had difficult intubation. Five independent factors were predictive of difficult intubation. The difficult airway assessment score that we developed to predict difficult airway intubation had an accuracy of 89%. A score of >4 increased the likelihood ratio of difficult intubation by 7.62 times.Conclusion: A difficult airway assessment score of >4 was associated with difficult intubation.


2021 ◽  
Vol 12 (24) ◽  
pp. 7399-7412
Author(s):  
Qian Wang ◽  
Xinguang Xiao ◽  
Yanchang Liang ◽  
Hao Wen ◽  
Xiaopeng Wen ◽  
...  

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Shamil D. Cooray ◽  
Jacqueline A. Boyle ◽  
Georgia Soldatos ◽  
Lihini A. Wijeyaratne ◽  
Helena J. Teede

Abstract Background Gestational diabetes (GDM) is increasingly common and has significant implications during pregnancy and for the long-term health of the mother and offspring. However, it is a heterogeneous condition with inter-related factors including ethnicity, body mass index and gestational weight gain significantly modifying the absolute risk of complications at an individual level. Predicting the risk of pregnancy complications for an individual woman with GDM presents a useful adjunct to therapeutic decision-making and patient education. Diagnostic prediction models for GDM are prevalent. In contrast, prediction models for risk of complications in those with GDM are relatively novel. This study will systematically review published prognostic prediction models for pregnancy complications in women with GDM, describe their characteristics, compare performance and assess methodological quality and applicability. Methods Studies will be identified by searching MEDLINE and Embase electronic databases. Title and abstract screening, full-text review and data extraction will be completed independently by two reviewers. The included studies will be systematically assessed for risk of bias and applicability using appropriate tools designed for prediction modelling studies. Extracted data will be tabulated to facilitate qualitative comparison of published prediction models. Quantitative data on predictive performance of these models will be synthesised with meta-analyses if appropriate. Discussion This review will identify and summarise all published prognostic prediction models for pregnancy complications in women with GDM. We will compare model performance across different settings and populations with meta-analysis if appropriate. This work will guide subsequent phases in the prognosis research framework: further model development, external validation and model updating, and impact assessment. The ultimate model will estimate the absolute risk of pregnancy complications for women with GDM and will be implemented into routine care as an evidence-based GDM complication risk prediction model. It is anticipated to offer value to women and their clinicians with individualised risk assessment and may assist decision-making. Ultimately, this systematic review is an important step towards a personalised risk-stratified model-of-care for GDM to allow preventative and therapeutic interventions for the maximal benefit to women and their offspring, whilst sparing expense and harm for those at low risk. Systematic review registration PROSPERO registration number CRD42019115223


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