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Original Research

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Predictors of difficult endotracheal intubation in the emergency department: a single-center pilot study

  • En-Chih Liao1,†
  • Wen-Han Chang1,2,3,4,5,6,†
  • Ching-Hsiang Yu1
  • Yat-Pang Chau1
  • Fang-Ju Sun7
  • Wen-Jyun Lai7
  • Ding-Kuo Chien1,2,3,4,5

1Department of Medicine, MacKay Medical College, New Taipei City, Taiwan

2Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan

3Mackay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan

4Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan

5Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan

6School of Medicine, Taipei Medical University, Taipei, Taiwan

7Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan

DOI: 10.22514/sv.2020.16.0118 Vol.17,Issue 2,March 2021 pp.77-84

Published: 08 March 2021

*Corresponding Author(s): Ding-Kuo Chien E-mail: anderson1021dr@gmail.com

† These authors contributed equally.

Abstract

Background: Identifying patients who are at risk of difficult endotracheal intubation is crucial in the emergency department. Therefore, this study evaluated the incidence and predictive factors of difficult tracheal intubation in the emergency department.

Methods: This was a 17-month prospective observational study. A difficult airway was defined as Cormack & Lehane classification grades III and IV at the first attempt of intubation. Patients who visited the emergency department, underwent traditional endotracheal intubation from participating physicians, and provided informed consent by themselves or via their delegates were enrolled in this study. Univariate associations between patient characteristics and difficult endotracheal intubation were identified, and statistically significant factors were included in a multivariate binary logistic regression model. A generalized association plot was used to show the relationships between variables.

Results: A total of 110 patients were enrolled in the study. The incidence of difficult intubation was 35.5% (39/110). In the difficult airway group, significantly higher body mass index (BMI), and incidence of double chin, thick short neck, Mallampati difficulty, small interincisor distance, small thyromental distance, and upper airway obstruction were noted on univariate analysis. A predictive formula for difficult tracheal intubation was successfully established by the combination of four independent predictors: BMI (odds ratio [OR] = 1.270), thyromental distance (OR = 0.614), upper airway obstruction (OR = 4.038), and Mallampati difficulty (OR = 5.163). A cutoff score of four maximized Youden’s index, providing sensitivity (79.5%) and specificity (81.7%) (95% CI: 0.794 to 0.938).

Conclusions: We used four predictors of difficult tracheal intubation, namely, BMI, thyromental distance, upper airway obstruction, and Mallampati difficulty, to create a predictive formula. This formula could help emergency physicians to quickly identify and carefully manage patients with difficult endotracheal intubation and consult experts early if necessary.

Keywords

Difficult endotracheal intubation; Body mass index; Thyromental distance; Upper airway obstruction; Mallampati score

Cite and Share

En-Chih Liao,Wen-Han Chang,Ching-Hsiang Yu,Yat-Pang Chau,Fang-Ju Sun,Wen-Jyun Lai,Ding-Kuo Chien. Predictors of difficult endotracheal intubation in the emergency department: a single-center pilot study. Signa Vitae. 2021. 17(2);77-84.

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