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Using Computed Tomography to Predict Difficult Tracheal Intubation

Dowdy, Regina Alma Evelyn
http://rave.ohiolink.edu/etdc/view?acc_num=osu1586195479987532

Abstract Details

2020, Master of Science, Ohio State University, Dentistry.
Objective: The unanticipated difficult airway is challenging to predict and can result in hypoxia or other events that can cause harm to the patient. There is currently not a single measure that can be used to predict an unanticipated difficult airway as many elements play different roles.a As a result, a combination of evaluations have been used to create a composite risk score with which to assess patients.b However, even current predictive models continue to show inaccuracy in identifying difficult cases. This study will compare fat volumes (as determined by computed tomography scan) with the Cormack-Lehane score from a general anesthetic with tracheal intubation that occurred within eight months of the scan. This goal of this study is to determine if submental or anterior neck fat volume is an indicator of difficult intubation. Methods: A total of 145 patients were included in this study. All patients will have previously undergone a tracheal intubation with a recorded Cormack-Lehane score and a neck computed tomography (CT) scan. Patients were divided into two groups dependent upon their Cormack-Lehane score with Group A being normal airway with a score of I or II and Group B being a difficult airway with a score of III or IV. Mallampati scores and intubation technique were also recorded. CT scans were performed on awake patients doing a breath hold in the supine position. The zone of interest being evaluated is the sagittal slice that corresponds from the hard palate to the inferior most tip of the epiglottis. This region is referred to as the neck volume, the area that will encompass all other structures being studied. Specific sub-parameters that will be measured include three dimensional volumes: airway volume, submental fat volume, and anterior neck fat volume. Results: Mallampati and Cormack-Lehane ranked scores were related and were found to be statistically significant, p=0.0035. The receiver operating characteristic (ROC) curve was found to be 0.8383 with minimum airway area and airway area being the factors that affected the Cormack-Lehane score Conclusions: Within the given data, there was insufficient evidence to indicate that the submental fat and anterior neck fat can be used as predictors of a higher Cormack-Lehane score. However, it was demonstrated that minimum airway and airway area found on CT imaging were better predictors of difficult intubation than BMI or other scan variables. When available, these features can be evaluated on the patient’s imaging and may be valuable for predicting higher Cormack-Lehane scores. However, due to the factors that would inhibit the routine use of preoperative CT neck imaging it would not be recommended to be incorporated based upon the results of this study.
Bryant Cornelius, DDS (Committee Chair)
Sonya Kalim, DMD, MDS (Committee Member)
Hany Emam, BDS, MS (Committee Member)
19 p.
Biomedical Engineering; Biomedical Research; Dentistry; Medical Imaging; Medicine; Radiology
Difficult Intubation, Computed Tomography, CT, Submental Fat, Anterior Neck Fat, BMI, laryngoscopy

Recommended Citations

Citations

  • Dowdy, R. A. E. (2020). Using Computed Tomography to Predict Difficult Tracheal Intubation [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1586195479987532

    APA Style (7th edition)

  • Dowdy, Regina. Using Computed Tomography to Predict Difficult Tracheal Intubation. 2020. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1586195479987532.

    MLA Style (8th edition)

  • Dowdy, Regina. "Using Computed Tomography to Predict Difficult Tracheal Intubation." Master's thesis, Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1586195479987532

    Chicago Manual of Style (17th edition)

osu1586195479987532
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This open access ETD is published by The Ohio State University and OhioLINK.