A novel comprehensive model of indicators reflecting the relative spatial position of the anterior cervical structures for predicting difficult laryngoscopy in patients with cervical spondylosis

IF 5.1 2区 医学 Q1 ANESTHESIOLOGY
Tianhao Zhang , Yujie Wang , Binlong Li, Rui Zhang, Wenxuan Liu, Bin Wei, Mao Xu
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引用次数: 0

Abstract

Background

Accurate assessment of difficult airway (DA) is critical, as failure to identify DA may lead to life-threatening complications. This study aimed to develop a multiparameter predictive model for DA using a novel ultrasound reference line (XU-line).

Methods

In this prospective, observational, single-blinded study, patients scheduled for elective cervical spondylosis surgery at Peking University Third Hospital underwent preoperative airway evaluation via physical indices and ultrasonography. Distances from the XU-line to six anatomical landmarks (hyoid bone, cricoid cartilage, epiglottis, vocal cords, thyroid isthmus, and suprasternal notch) were measured both in supine and sniffing positions. Participants were stratified into “easy laryngoscopy” and “difficult laryngoscopy” groups based on Cormack–Lehane (C-L) grades. Multivariate logistic regression identified independent predictors of difficult laryngoscopy.

Results

There were significant differences in the thirteen clinical factors between the two groups. Sex, modified Mallampati test, skin-to-epiglottis distance (neutral position), XU-line-to-vocal-cords distance (sniffing position), and spatial distances from XU-line to cricoid cartilage were found to be independent risk factors for difficult laryngoscopy. A combined model incorporating these five factors demonstrated superior predictive performance (sensitivity: 82.0 %; specificity: 61 %) compared to individual clinical predictors or traditional clinical models.

Conclusion

The spatial relationship between cervical airway structures and the XU-line may serve as a novel predictive index in a comprehensive DA assessment model.
一种反映颈前结构相对空间位置的新型综合指标模型,用于预测颈椎病患者喉镜检查困难
准确评估困难气道(DA)是至关重要的,因为不能识别DA可能导致危及生命的并发症。本研究旨在建立一种新型超声参考线(XU-line)的多参数DA预测模型。方法在本前瞻性、观察性、单盲研究中,在北京大学第三医院择期颈椎病手术的患者术前通过体格指标和超声检查对气道进行评估。在仰卧位和吸气位测量从xu线到六个解剖标志(舌骨、环状软骨、会厌、声带、甲状腺峡和胸骨上切迹)的距离。参与者根据Cormack-Lehane (C-L)分级分为“易喉镜检查”和“难喉镜检查”组。多因素logistic回归确定了喉镜检查困难的独立预测因素。结果两组患者13项临床指标差异均有统计学意义。性别、改良Mallampati试验、皮肤到会厌的距离(中性体位)、徐线到声带的距离(吸气体位)、徐线到环状软骨的空间距离是喉镜检查困难的独立危险因素。结合这五个因素的组合模型显示出更好的预测性能(灵敏度:82.0%;特异性:61%)与单个临床预测因子或传统临床模型相比。结论颈椎气道结构与xu线的空间关系可作为DA综合评估模型的一种新的预测指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.40
自引率
4.50%
发文量
346
审稿时长
23 days
期刊介绍: The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.
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