RESUMO
Abstract Background and objectives: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. Methods: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. Results: A total of 25.4% of the patients had difficult intubations. SPIDS scores >10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. Conclusions: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.
Resumo Justificativa e objetivos: Neste estudo, avaliamos o valor preditivo de diferentes ferramentas de avaliação das vias aéreas, incluindo componentes do Escore Simplificado Preditivo de Intubação Difícil (ESPID), o próprio ESPID e a Medida da Altura Tireomentoniana (MATM), em intubações definidas como difícies pelo Escore de Dificuldade de Intubação (EDI) em um grupo de pacientes com patologia de cabeça e pescoço. Método: Incluímos no estudo 153 pacientes submetidos a cirurgia de cabeça e pescoço. Coletamos os resultados do Teste de Mallampati Modificado (TMM), Distância Tireomentoniana (DTM), Razão Altura/Distância Tireomentoniana (RADTM), MATM, amplitude máxima de movimentação da cabeça e pescoço e da abertura da boca. Os ESPIDs foram calculados e os EDIs, determinados. Resultados: Observamos intubação difícil em 25,4% dos pacientes. Os escores de ESPID > 10 tiveram sensibilidade de 86,27%, especificidade de 71,57% e valor preditivo negativo de 91,2% (VPN). O resultado da análise da curva de operação do receptor (curva ROC) para os testes de avaliação das vias aéreas e ESPID mostrou que o ESPID tinha a maior área sob a curva; no entanto, foi estatisticamente semelhante a outros testes, exceto para o TMM. Conclusões: O presente estudo demonstra o uso prático do ESPID na previsão da dificuldade de intubação em pacientes com patologia de cabeça e pescoço. O desempenho do ESPID na predição de via aérea difícil mostrou-se tão eficiente quanto os demais testes avaliados neste estudo. O ESPID pode ser considerado ferramenta abrangente e detalhada para prever via aérea difícil.
Assuntos
Humanos , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Intubação Intratraqueal/métodos , Pescoço/cirurgia , Esvaziamento Cervical/estatística & dados numéricos , Glândula Tireoide/cirurgia , Neoplasias da Língua/cirurgia , Neoplasias Nasofaríngeas , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Amplitude de Movimento Articular , Sensibilidade e Especificidade , Avaliação de Resultados em Cuidados de Saúde , Avanço Mandibular , Neoplasias de Cabeça e Pescoço/cirurgia , Intubação Intratraqueal/instrumentação , Laringectomia/estatística & dados numéricos , Traumatismos Maxilofaciais/cirurgia , Pessoa de Meia-Idade , Boca/fisiologia , Pescoço/anatomia & histologiaRESUMO
BACKGROUND AND OBJECTIVES: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. METHODS: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion, and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. RESULTS: A total of 25.4% of the patients had difficult intubations. SPIDS scores > 10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. CONCLUSIONS: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.
Assuntos
Intubação Intratraqueal/métodos , Pescoço/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Intubação Intratraqueal/instrumentação , Laringectomia/estatística & dados numéricos , Avanço Mandibular , Traumatismos Maxilofaciais/cirurgia , Pessoa de Meia-Idade , Boca/fisiologia , Neoplasias Nasofaríngeas , Pescoço/anatomia & histologia , Esvaziamento Cervical/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Amplitude de Movimento Articular , Sensibilidade e Especificidade , Glândula Tireoide/cirurgia , Neoplasias da Língua/cirurgia , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: The prediction of difficult laryngoscopy is based on tests that assess anatomic characteristics of face and neck. We aimed to identify the most accurate tests and propose a multivariate predictive model. METHODS: This prospective observational study included 1134 patients. Thyromental Distance (TMD), Sternomental Distance (STMD), Ratio of Height-to-Thyromental Distance (R-H/TMD), Neck Circumference (NC), Ratio of Neck Circumference-to-Thyromental Distance (R-NC/TMD), Hyomental Distance with head in Neutral Position (HMD-NP) and at Maximal Extension (HMD-HE), Ratio of Hyomental Distance at Maximal head extension-to-hyomental distance in neutral position (R-HMD), Mallampati Class (MLC), Upper Lip Bite Test (ULBT), Mouth Opening (MO) and Head Extension (HE) were assessed preoperatively. A Cormack-Lehane Grade ≥ 3 was defined as Difficult Laryngoscopy. Sensitivity, specificity, positive and negative predictive values were assessed for all tests. Multivariate analysis with logistic regression was used to create the predictive models. RESULTS: A model incorporating MLC, ULBT, HE, HMD-HE and R-NC/TMD showed high prognostic accuracy; x2(5)=109.12, p <0.001, AUC=0.86, p <0.001). Its sensitivity, specificity and negative predictive value were 82.3%, 74.8% and 97.4%, respectively. A second model including two measurements not requiring patient's cooperation (R-NC/TMD and HMD-HE) exhibited good prognostic performance; x2(2)=63.5, p <0.001, AUC=0.77, p <0.001. Among single tests, HE had the highest sensitivity (78.5%) and negative predictive value (96%). CONCLUSIONS: A five-variable model incorporating MLC, ULBT, HE, HMD-HE and R-NC/TMD showed satisfyingly high predictive value for difficult laryngoscopy. A model including R-NC/TMD and HMD-HE could be useful in incapable patients. The most accurate single predictor was HE.
Assuntos
Laringoscopia , Modelos Estatísticos , Testes Imediatos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
Abstract Background and objectives: The prediction of difficult laryngoscopy is based on tests that assess anatomic characteristics of face and neck. We aimed to identify the most accurate tests and propose a multivariate predictive model. Methods: This prospective observational study included 1134 patients. Thyromental Distance (TMD), Sternomental Distance (STMD), Ratio of Height-to-Thyromental Distance (R-H/TMD), Neck Circumference (NC), Ratio of Neck Circumference-to-Thyromental Distance (R-NC/TMD), Hyomental Distance with head in Neutral Position (HMD-NP) and at Maximal Extension (HMD-HE), Ratio of Hyomental Distance at Maximal head extension-to-hyomental distance in neutral position (R-HMD), Mallampati Class (MLC), Upper Lip Bite Test (ULBT), Mouth Opening (MO) and Head Extension (HE) were assessed preoperatively. A Cormack-Lehane Grade ≥ 3 was defined as Difficult Laryngoscopy. Sensitivity, specificity, positive and negative predictive values were assessed for all tests. Multivariate analysis with logistic regression was used to create the predictive models. Results: A model incorporating MLC, ULBT, HE, HMD-HE and R-NC/TMD showed high prognostic accuracy; x2(5) = 109.12, p < 0.001, AUC = 0.86, p < 0.001). Its sensitivity, specificity and negative predictive value were 82.3%, 74.8% and 97.4%, respectively. A second model including two measurements not requiring patient's cooperation (R-NC/TMD and HMD-HE) exhibited good prognostic performance; x2(2) = 63.5, p < 0.001, AUC = 0.77, p < 0.001. Among single tests, HE had the highest sensitivity (78.5%) and negative predictive value (96%). Conclusions: A five-variable model incorporating MLC, ULBT, HE, HMD-HE and R-NC/TMD showed satisfyingly high predictive value for difficult laryngoscopy. A model including R-NC/TMD and HMD-HE could be useful in incapable patients. The most accurate single predictor was HE.
Resumo Justificativa e objetivos: A previsão de laringoscopia difícil se baseia em testes que avaliam as características anatômicas da face e pescoço. Nosso objetivo foi identificar os testes mais precisos e propor modelo preditivo multivariado. Método: Estudo observacional prospectivo incluiu 1134 pacientes e avaliou no pré-operatório: Distância Tireomentoniana (DTM), Distância Esternomentoniana (DEM), razão Altura-Distância Tireomentoniana (A/DTM), Circunferência Cervical (CC), razão Circunferência Cervical-Distância Tireomentoniana (CC/DTM), Distância Hiomentoniana com a cabeça na Posição Neutra (DHM-PN) e em Extensão Máxima (DHM-EM), razão Distância Hiomentoniana com Cabeça em Extensão Máxima/Distância Hiomentoniana na posição Neutra (DHME/DHMN), Classe Mallampati (CML), Teste da Mordida do Lábio Superior (TMLS), Abertura da Boca (AB) e Extensão da Cabeça (EC). Grau Cormack-Lehane ≥ 3 foi definido como Laringoscopia Difícil. A sensibilidade, especificidade, valores preditivos positivo e negativo foram avaliados para todos os testes. A análise multivariada com regressão logística foi usada para criar modelos preditivos. Resultados: Um modelo incorporando CML, TMLS, EC, DHM-EM e CC/DTM demonstrou alta precisão prognóstica (x2(5) = 109,12, p < 0,001, AUC = 0,86, p < 0,001). A sensibilidade, especificidade e valor preditivo negativo foram 82,3%, 74,8% e 97,4%, respectivamente. Um segundo modelo incluindo duas medidas que não necessitavam da cooperação do paciente (CC/DTM e DHM-EM) demonstrou bom desempenho prognóstico (x2 (2) = 63,5; p < 0,001; AUC = 0,77, p < 0,001). Entre os testes individuais, EC teve a maior sensibilidade (78,5%) e valor preditivo negativo (96%). Conclusões: O modelo de cinco variáveis incorporando CML, TMLS, EC, DHM-EM e CC/DTM mostrou valor preditivo satisfatoriamente alto para laringoscopia difícil. Um modelo que incluísse CC/DTM e DHM-EM poderia ser útil em pacientes com incapacidade. O preditor individual mais preciso foi EC.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Modelos Estatísticos , Testes Imediatos , Laringoscopia , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Pessoa de Meia-IdadeRESUMO
"O estudo a seguir descreve em detalhes a abordagem da via aérea difícil, desde o momento que precede a cirurgia até os cuidados pós-operatórios. Focando em praticidade e eficiência nos momentos de decisões cruciais, este trabalho se baseia principalmente em evidências científicas e guidelines atualizados pela American Society of Anesthesiologists, procurando estabelecer padrões de ações que possam impactar na morbidade e mortalidade de forma significativa. A avaliação préoperatória é de fundamental importância para o anestesiologista de modo a antecipar possíveis intercorrências e dificuldade no momento de acessar uma via aérea definitiva. No momento da indução anestésica, o anestesiologista, precisa ter ao seu alcance, principalmente quando se depara com uma via aérea difícil não antecipada, alternativas à laringoscopia direta em que este tenha prática e, em casos de hipoxemia sanguínea um plano B imediato de forma a poder administrar oxigênio ao paciente durante os momentos críticos, sem aumentar a chance de complicações. Diversos são os equipamentos e técnicas disponíveis na anestesia moderna, usados como alternativa ao método convencional de intubação traqueal, que serão especificados adiante. Gestantes, politraumatizados e pacientes pediátricos exigem uma atenção especial devido a alterações fisiológicas presentes. Cuidados pós-operatórios incluem o registro em prontuário sobre as dificuldades observadas e os meios utilizados para solucioná-las, além da pronta comunicação ao paciente e familiares com o objetivo de passar adiante a informação e evitar complicações em futuros procedimentos anestésicos."(AU)
"The following study describes in detail the difficult airway approach, from the time before surgery to postoperative care. Focusing on practicality and efficiency at crucial decision moments, this paper is based primarily on scientific evidence and guidelines updated by the American Society of Anesthesiologists, seeking to establish standards of action that can have significant impact on morbidity and mortality. The preoperative evaluation is of fundamental importance for the anesthesiologist in order to anticipate possible intercurrences and difficulties in the moment of assessing a definitive airway. At the time of anesthetic induction, the anesthesiologist must have within his reach, especially when faced with an unanticipated difficult airway, alternatives to direct laryngoscopy in which he has practice, and in cases of blood hypoxemia, an immediate B plane aiming to administer oxygen to the patient at critical moments, without increasing the chance of complications. Several equipment and techniques are available in modern anesthesia as an alternative to the conventional method of tracheal intubation, which will be further specified below. Pregnant women, polytrauma patients and pediatric patients require special attention due to physiological changes present. Postoperative care includes keeping records of the established difficulties and the means used to solve them, as well as prompt communication with the patient and family with the purpose of passing this on and avoid complications in future anesthetic procedures."(AU)
Assuntos
Humanos , Masculino , Feminino , Cuidados Pós-Operatórios/métodos , Algoritmos , Cuidados Pré-Operatórios/métodos , Manuseio das Vias Aéreas , Intubação Intratraqueal , Padrões de Referência , Atenção , Mortalidade , Anestesiologistas , Intubação , Anestesia , AnestésicosRESUMO
Transverse maxillary deficiency is commonly found in patients with sleep apnea and is also related to abnormal breathing patterns. Maxillary expansion procedures promote widening of the nasal floor and reduce the resistance to airflow, and have a positive influence on nasopharynx function. In order to evaluate volume changes in the upper airway, 15 adult patients with transverse maxillary deficiency underwent surgically assisted rapid maxillary expansion (RME) until a slight overcorrection of the crossbite was obtained. Cone beam computed tomography (CBCT) volumetric images were obtained at three predefined time points. The mean age of the patients was 30.2 (±7.4) years; nine were females and six were males. The area, volume, and the smallest transverse section area of the airway were assessed using Dolphin Imaging 3D software. Statistical comparisons were made of the changes between time periods. No statistically significant differences were found for volume or area. However a significant difference was found between the preoperative and immediate postoperative smallest transverse section area (P<0.05). Maxillary expansion, as an isolated procedure, does not result in a statistically significant improvement in the airway dimensions and results in an inferior relocation of the smallest transverse section area.