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Incidence and predictors of difficult mask ventilation and intubation

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Incidence and predictors of difficult mask ventilation and intubation

Auteurs : Prerana N. Shah ; Vimal Sundaram

Source :

Journal of Anaesthesiology, Clinical Pharmacology [ 0970-9185 ] ; 2012.

RBID : PMC:3511939

Abstract

Background:

This study is aimed to determine the incidence and predictors of difficult and impossible mask ventilation.

Materials and Methods:

Information like age, snoring history, obstructive sleep apnea, dental and mandibular abnormalities, macroglossia, grading like SLUX, Mallampatti, Cormack Lehanne, atlantooccipital extension, presence of beard or moustache, mouth opening were collected. During mask ventilation, the information related to the ventilation and intubation was collected. All variables found to be significant in univariate analysis were subjected to the multivariate logistic regression model to identify independent predictors of measured outcome.

Results:

Difficult mask ventilation (DMV) was observed in 30 male patients and 9 female patients. Of the 40 patients who had difficult intubation (DI), 7 patients had both DMV and intubation and 1 patient was of impossible mask ventilation/ intubation. Snoring was the lone significant risk factor for DMV. The risk factors identified for DI were snoring, retrognathia, micrognathia, macroglossia, short thick neck, Mallampatti grade [III/IV], abnormal SLUX grade, Cormack Lehanne grade [II,III/IV], abnormal atlantooccipital extension grading, flexion/extension deformity of neck, protuberant teeth, cervical spine abnormality, mouth opening < 3 cm, and BMI > 26 kg/m². BMI > 26 kg/m² and atlantooccipital extension grade > 3 were independent risk factors for DI and the presence of two of the variables made the sensitivity and specificity of 43% and 99% respectively with a positive predictive value of 74%.

Conclusions:

The predictive score may lead to a better anticipation of difficult airway management, potentially deceasing the morbidity and mortality resulting from hypoxia or anoxia with failed ventilation.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511939

DOI: 10.4103/0970-9185.101901
PubMed: 23225922
PubMed Central: 3511939

Affiliations:

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PMC:3511939

Le document en format XML

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<author><name sortKey="Shah, Prerana N" sort="Shah, Prerana N" uniqKey="Shah P" first="Prerana N" last="Shah">Prerana N. Shah</name>
<affiliation><nlm:aff id="aff1">Department of Anaesthesiology, Seth G S Medical College and KEM Hospital, Parel, Mumbai</nlm:aff>
<wicri:noCountry code="subfield">Mumbai</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Sundaram, Vimal" sort="Sundaram, Vimal" uniqKey="Sundaram V" first="Vimal" last="Sundaram">Vimal Sundaram</name>
<affiliation><nlm:aff id="aff1">Department of Anaesthesiology, Seth G S Medical College and KEM Hospital, Parel, Mumbai</nlm:aff>
<wicri:noCountry code="subfield">Mumbai</wicri:noCountry>
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<author><name sortKey="Shah, Prerana N" sort="Shah, Prerana N" uniqKey="Shah P" first="Prerana N" last="Shah">Prerana N. Shah</name>
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<wicri:noCountry code="subfield">Mumbai</wicri:noCountry>
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<author><name sortKey="Sundaram, Vimal" sort="Sundaram, Vimal" uniqKey="Sundaram V" first="Vimal" last="Sundaram">Vimal Sundaram</name>
<affiliation><nlm:aff id="aff1">Department of Anaesthesiology, Seth G S Medical College and KEM Hospital, Parel, Mumbai</nlm:aff>
<wicri:noCountry code="subfield">Mumbai</wicri:noCountry>
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<series><title level="j">Journal of Anaesthesiology, Clinical Pharmacology</title>
<idno type="ISSN">0970-9185</idno>
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<front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title>
<p>This study is aimed to determine the incidence and predictors of difficult and impossible mask ventilation.</p>
</sec>
<sec id="st2"><title>Materials and Methods:</title>
<p>Information like age, snoring history, obstructive sleep apnea, dental and mandibular abnormalities, macroglossia, grading like SLUX, Mallampatti, Cormack Lehanne, atlantooccipital extension, presence of beard or moustache, mouth opening were collected. During mask ventilation, the information related to the ventilation and intubation was collected. All variables found to be significant in univariate analysis were subjected to the multivariate logistic regression model to identify independent predictors of measured outcome.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>Difficult mask ventilation (DMV) was observed in 30 male patients and 9 female patients. Of the 40 patients who had difficult intubation (DI), 7 patients had both DMV and intubation and 1 patient was of impossible mask ventilation/ intubation. Snoring was the lone significant risk factor for DMV. The risk factors identified for DI were snoring, retrognathia, micrognathia, macroglossia, short thick neck, Mallampatti grade [III/IV], abnormal SLUX grade, Cormack Lehanne grade [II,III/IV], abnormal atlantooccipital extension grading, flexion/extension deformity of neck, protuberant teeth, cervical spine abnormality, mouth opening < 3 cm, and BMI > 26 kg/m<sup>2</sup>
. BMI > 26 kg/m<sup>2</sup>
 and atlantooccipital extension grade > 3 were independent risk factors for DI and the presence of two of the variables made the sensitivity and specificity of 43% and 99% respectively with a positive predictive value of 74%.</p>
</sec>
<sec id="st4"><title>Conclusions:</title>
<p>The predictive score may lead to a better anticipation of difficult airway management, potentially deceasing the morbidity and mortality resulting from hypoxia or anoxia with failed ventilation.</p>
</sec>
</div>
</front>
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<author><name sortKey="Masso, E" uniqKey="Masso E">E Masso</name>
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<author><name sortKey="Huraux, C" uniqKey="Huraux C">C Huraux</name>
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<author><name sortKey="Guggiari, M" uniqKey="Guggiari M">M Guggiari</name>
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<author><name sortKey="Bianchi, A" uniqKey="Bianchi A">A Bianchi</name>
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<author><name sortKey="Coriat, P" uniqKey="Coriat P">P Coriat</name>
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<author><name sortKey="Mc Carthy, R" uniqKey="Mc Carthy R">R Mc Carthy</name>
</author>
<author><name sortKey="Tuman, K" uniqKey="Tuman K">K Tuman</name>
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<author><name sortKey="Tanck, E" uniqKey="Tanck E">E Tanck</name>
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<author><name sortKey="O Eilly, M" uniqKey="O Eilly M">M O’Reilly</name>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">J Anaesthesiol Clin Pharmacol</journal-id>
<journal-id journal-id-type="iso-abbrev">J Anaesthesiol Clin Pharmacol</journal-id>
<journal-id journal-id-type="publisher-id">JOACP</journal-id>
<journal-title-group><journal-title>Journal of Anaesthesiology, Clinical Pharmacology</journal-title>
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<issn pub-type="ppub">0970-9185</issn>
<issn pub-type="epub">2231-2730</issn>
<publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name>
<publisher-loc>India</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">23225922</article-id>
<article-id pub-id-type="pmc">3511939</article-id>
<article-id pub-id-type="publisher-id">JOACP-28-451</article-id>
<article-id pub-id-type="doi">10.4103/0970-9185.101901</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Incidence and predictors of difficult mask ventilation and intubation</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Shah</surname>
<given-names>Prerana N</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sundaram</surname>
<given-names>Vimal</given-names>
</name>
<xref ref-type="aff" rid="aff1"></xref>
</contrib>
</contrib-group>
<aff id="aff1">Department of Anaesthesiology, Seth G S Medical College and KEM Hospital, Parel, Mumbai</aff>
<author-notes><corresp id="cor1"><bold>Address for correspondence:</bold>
 Dr. Prerana N Shah, 73B, Varma Villa, Vitthalbhai Road, Vile Parle West Mumbai 400 056, India. E-mail: <email xlink:href="pps@kem.edu">pps@kem.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Oct-Dec</season>
<year>2012</year>
</pub-date>
<volume>28</volume>
<issue>4</issue>
<fpage>451</fpage>
<lpage>455</lpage>
<permissions><copyright-statement>Copyright: © Journal of Anaesthesiology Clinical Pharmacology</copyright-statement>
<copyright-year>2012</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec id="st1"><title>Background:</title>
<p>This study is aimed to determine the incidence and predictors of difficult and impossible mask ventilation.</p>
</sec>
<sec id="st2"><title>Materials and Methods:</title>
<p>Information like age, snoring history, obstructive sleep apnea, dental and mandibular abnormalities, macroglossia, grading like SLUX, Mallampatti, Cormack Lehanne, atlantooccipital extension, presence of beard or moustache, mouth opening were collected. During mask ventilation, the information related to the ventilation and intubation was collected. All variables found to be significant in univariate analysis were subjected to the multivariate logistic regression model to identify independent predictors of measured outcome.</p>
</sec>
<sec id="st3"><title>Results:</title>
<p>Difficult mask ventilation (DMV) was observed in 30 male patients and 9 female patients. Of the 40 patients who had difficult intubation (DI), 7 patients had both DMV and intubation and 1 patient was of impossible mask ventilation/ intubation. Snoring was the lone significant risk factor for DMV. The risk factors identified for DI were snoring, retrognathia, micrognathia, macroglossia, short thick neck, Mallampatti grade [III/IV], abnormal SLUX grade, Cormack Lehanne grade [II,III/IV], abnormal atlantooccipital extension grading, flexion/extension deformity of neck, protuberant teeth, cervical spine abnormality, mouth opening < 3 cm, and BMI > 26 kg/m<sup>2</sup>
. BMI > 26 kg/m<sup>2</sup>
 and atlantooccipital extension grade > 3 were independent risk factors for DI and the presence of two of the variables made the sensitivity and specificity of 43% and 99% respectively with a positive predictive value of 74%.</p>
</sec>
<sec id="st4"><title>Conclusions:</title>
<p>The predictive score may lead to a better anticipation of difficult airway management, potentially deceasing the morbidity and mortality resulting from hypoxia or anoxia with failed ventilation.</p>
</sec>
</abstract>
<kwd-group><kwd>Airway</kwd>
<kwd>difficult ventilation</kwd>
<kwd>difficult intubation</kwd>
<kwd>mask</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list></list>
<tree><noCountry><name sortKey="Shah, Prerana N" sort="Shah, Prerana N" uniqKey="Shah P" first="Prerana N" last="Shah">Prerana N. Shah</name>
<name sortKey="Sundaram, Vimal" sort="Sundaram, Vimal" uniqKey="Sundaram V" first="Vimal" last="Sundaram">Vimal Sundaram</name>
</noCountry>
</tree>
</affiliations>
</record>

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Incidence and predictors of difficult mask ventilation and intubation

Incidence and predictors of difficult mask ventilation and intubation

Source :

Abstract

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