A simple predictive rule based on adverse risk factors can identify patients who may be difficult to intubate.
Difficulty at laryngoscopy defined as the inability to see the arytenoids.
Risk factors:
(1) body weight
(2) head and neck movement
(3) jaw movement, based on inter-incisor gap and subluxation
(4) receding mandible
(5) buck teeth
|
Risk Factor |
Finding |
Level |
|
weight |
< 90 kg |
0 |
|
|
90 - 110 kg |
1 |
|
|
> 110 kg |
2 |
|
head and neck movement |
> 90° |
0 |
|
|
about 90° |
1 |
|
|
< 90° |
2 |
|
jaw movement |
inter-incisor gap >= 5 cm or subluxation > 0 |
0 |
|
|
inter-incisor gap < 5 cm and subluxation = 0 |
1 |
|
|
inter-incisor gap < 5 cm and subluxation < 0 |
2 |
|
receding mandible |
normal |
0 |
|
|
moderate |
1 |
|
|
severe |
2 |
|
buck teeth |
normal |
0 |
|
|
moderate |
1 |
|
|
severe |
2 |
risk sum score =
= (level for weight) + (level for head and neck movement) + (level for jaw movement) + (level for receding mandible) + (level for buck teeth)
Interpretation:
• minimum score: 0
• maximum score: 10
• The decision level selected depends on the prevalence of difficult intubations in the population and the tolerance for missing a difficult intubation. Using a lower risk sum score will include more cases of difficult intubation, but would include more cases as "false positives" (not difficult to intubate).
|
Risk Sum Score |
percent of patients difficult to intubate |
percent of patient not difficult to intubate included |
|
>= 1 |
92% |
26% |
|
>= 2 |
75% |
12% |
|
>= 3 |
50% |
4.6% |
|
>= 4 |
42% |
0.8% |
|
>= 5 |
17% |
0.3% |
|
>= 6 |
8% |
0% |
Specialty: Anesthesiology, Surgery, general, Pulmonology, Cardiology, Emergency Medicine, Otolaryngology
ICD-10: ,
