The value of a relatively safe method for predicting difficult laryngoscopy during the COVID-19 epidemic

Abstract Background: The current global situation of COVID-19 epidemic is serious. Routine preoperative methods to assess airway such as the interincisor distance, Mallampati classification, and the upper lip bite test have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, interincisor distance, and upper lip bite test) remains unknown. The purpose of this study was to observe the value of condyle-tragus maximal distance to predict difficult laryngoscopy, and provide a new idea for preoperative airway assessment during epidemic. Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The interincisor distance, Mallampati test result, upper lip bite test result, and the condyle-tragus maximal distance of each patient were evaluated prior to the initiation of anesthesia. The primary outcome was difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2. Results: A total of 304 patients were successfully included in the study ,39 patients were identified as difficult laryngoscopy. The correlation between the condyle-tragus maximal distance and Cormack-Lehane Level was the highest (Spearman correlation coefficient, -0.317; P＜0.001), and the area under the ROC curve was the highest (AUC：0.699,P＜0.01). The condyle-tragus maximal distance <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;99% CI,0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865). Conclusion: Compared with the interincisor distance , Mallampati classification and the upper lip bite test, the condyle-tragus maximal distance has higher value in predicting difficult laryngoscopy, which can become a safer airway assessment method during the epidemic of COVID-19. Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

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The value of a method to reduce the exposure of the upper respiratory tract for predicting difficult laryngoscopy

10.21203/rs.3.rs-60902/v2 ◽

2020 ◽

Author(s):

Hao Wu ◽

Dandan Hu ◽

Xu Chen ◽

Xuebing Zhang ◽

Min Xia ◽

...

Keyword(s):

Respiratory Tract ◽

Predictive Value ◽

Assessment Method ◽

Difficult Laryngoscopy ◽

Upper Respiratory Tract ◽

Intubation Time ◽

Clinical Trial Registry ◽

Airway Assessment ◽

Upper Respiratory ◽

Interincisor Distance

Abstract Background: The current global situation of COVID-19 epidemic is serious. Routine preoperative methods to assess airway such as the interincisor distance(IID), Mallampati classification, and the upper lip bite test(ULBT) have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic.Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The IID, Mallampati test result, ULBT result, and the C-TMD of each patient were evaluated prior to the initiation of anesthesia. The primary outcome were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 , the number of intubation attempts and intubation time.Results: A total of 304 patients were successfully included in the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD ＞1 finger group 46.8±7.3s, compared with the C-TMD ＜1 finger group 50.8±8.6s (p＜0.01).First attempt success rate was higher in the C-TMD ＞1 finger group than in the C-TMD ＜1 finger group (P＜0.01).The correlation between the C-TMD and Cormack-Lehane Level was 0.317(Spearman correlation coefficient, P＜0.001), and the area under the ROC curve was 0.699(P＜0.01). The C-TMD <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;95%CI: 0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865).Conclusion: Compared with the IID , Mallampati classification and ULBT, the C-TMD has higher value in predicting difficult laryngoscopy, which can become a more favorable airway assessment method during the epidemic of COVID-19.Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

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The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract: a prospective observational study

10.21203/rs.3.rs-60902/v3 ◽

2020 ◽

Author(s):

Hao Wu ◽

Dandan Hu ◽

Xu Chen ◽

Xuebing Zhang ◽

Min Xia ◽

...

Keyword(s):

Respiratory Tract ◽

Predictive Value ◽

Assessment Method ◽

Difficult Laryngoscopy ◽

Upper Respiratory Tract ◽

Intubation Time ◽

Clinical Trial Registry ◽

Finger Width ◽

Upper Respiratory ◽

Interincisor Distance

Abstract Background: Routine preoperative methods to assess airway such as the interincisor distance(IID), Mallampati classification, and the upper lip bite test(ULBT) have a certain risk of upper respiratory tract exposure and virus spread. The condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and the assessment method does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. Methods: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The IID, Mallampati classification, ULBT, and the C-TMD of each patient were evaluated prior to the initiation of anesthesia. The primary outcome was intubation time. The second outcome were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. Results: A total of 304 patients were successfully included in the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD＞1 finger group 46.8±7.3s, compared with the C-TMD＜1 finger group 50.8±8.6s (p＜0.01). First attempt success rate was higher in the C-TMD＞1 finger group 98.9% than in the C-TMD＜1 finger group 87.1% (P＜0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317(Spearman correlation coefficient, P＜0.001), and the area under the ROC curve was 0.699(P＜0.01). The C-TMD <1 finger width was the most consistent with difficult laryngoscopy (κ=0.485;95%CI:0.286-0.612) and its OR value was 10.09(95%CI: 4.19-24.28), sensitivity was 0.469(95%CI: 0.325-0.617), specificity was 0.929(95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847(95%CI :0.825-0.865).Conclusion: Compared with the IID , Mallampati classification and ULBT, the C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract.Trial registration: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

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The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract; a prospective observational study

BMC Anesthesiology ◽

10.1186/s12871-021-01253-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hao Wu ◽

Dandan Hu ◽

Xu Chen ◽

Xuebing Zhang ◽

Min Xia ◽

...

Keyword(s):

Respiratory Tract ◽

Predictive Value ◽

Prospective Observational Study ◽

Difficult Laryngoscopy ◽

Upper Respiratory Tract ◽

Intubation Time ◽

Clinical Trial Registry ◽

Finger Width ◽

Upper Respiratory ◽

Interincisor Distance

Abstract Background Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. Methods Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. Results Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient, P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286–0.612) and its OR value was 10.09 (95%CI: 4.19–24.28), sensitivity was 0.469 (95%CI: 0.325–0.617), specificity was 0.929 (95%CI: 0.877–0.964), positive predictive value was 0.676 (95%CI: 0.484–0.745), negative predictive value was 0.847 (95%CI: 0.825–0.865). Conclusion Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract. Trial registration The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900026775).

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Relationship Between Upper Respiratory Tract Influenza Test Result and Clinical Outcomes Among Critically Ill Influenza Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw023 ◽

2016 ◽

Vol 3 (1) ◽

Cited By ~ 10

Author(s):

Krishna P. Reddy ◽

Ednan K. Bajwa ◽

Robert A. Parker ◽

Andrew B. Onderdonk ◽

Rochelle P. Walensky

Keyword(s):

Respiratory Tract ◽

Disease Progression ◽

Clinical Outcomes ◽

Critically Ill ◽

Critically Ill Patients ◽

Lower Respiratory Tract ◽

Diagnostic Yield ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Test Result

Abstract Among critically ill patients with lower respiratory tract (LRT)-confirmed influenza, we retrospectively observed worse 28-day clinical outcomes in upper respiratory tract (URT)-negative versus URT-positive subjects. This finding may reflect disease progression and highlights the need for influenza testing of both URT and LRT specimens to improve diagnostic yield and possibly inform prognosis.

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