Early Identification of Patients at Risk for Difficult Intubation in the Intensive Care Unit

• DOI: 10.1164/rccm.201210-1851oc
• Publication Date: 2013-01-25T00:32:47Z
• Authors: Audrey De Jong; Nicolas Molinari; Nicolas Terzi; Nicolas Mongardon; Jean-Michel Arnal; Christophe Guitton; Bernard Allaouchiche; Catherine Paugam-...; Jean-Michel Const...; Jean-Yves Lefrant; Marc Leone; Laurent Papazian; Karim Asehnoune; Nicolas Maziers; Elie Azoulay; Gael Pradel; Boris Jung; Samir Jaber
• Keywords: Male; Mouth; Sleep Apnea, Obstructive; Reproducibility of Results; Middle Aged; Risk Assessment; Severity of Illness Index; Body Mass Index; 3. Good health; Intensive Care Units; 03 medical and health sciences; Logistic Models; 0302 clinical medicine; Area Under Curve; Multivariate Analysis; Cervical Vertebrae; Intubation, Intratracheal; Humans; Female; Prospective Studies; Mobility Limitation; Aged

Difficult intubation in the intensive care unit (ICU) is a challenging issue.To develop and validate simplified score for identifying patients with difficult ICU to report related complications.Data collected prospective multicenter study from 1,000 consecutive intubations 42 ICUs were used of intubation, which was then validated externally 400 procedures 18 other internally by bootstrap on iterations.In multivariate analysis, main predictors (incidence = 11.3%) patient (Mallampati III or IV, obstructive sleep apnea syndrome, reduced mobility cervical spine, limited mouth opening); pathology (severe hypoxia, coma); operator (nonanesthesiologist). From β parameter, seven-item (MACOCHA score) built, an area under curve (AUC) 0.89 (95% confidence interval [CI], 0.85-0.94). In validation cohort (prevalence 8%), AUC 0.86 CI, 0.76-0.96), sensitivity 73%, specificity 89%, negative predictive value 98%, positive 36%. After internal bootstrap, 0.86-0.93). Severe life-threatening events collapse, cardiac arrest, death) occurred 38% cases. Patients (n 113) had significantly higher severe complications than those who nondifficult (51% vs. 36%; P < 0.0001).Difficult strongly associated complications. A simple including seven clinical items discriminates ICU. Clinical trial registered www.clinicaltrials.gov (NCT 01532063).