A new score for airway assessment using clinical and ultrasound parameters.

Background: Over the last few years, ultrasonography has been introduced as the fifth pillar to patient's bedside physical examination. Clinical assessments aim to screen and look for airway difficulties to predict difficult intubations, but none have demonstrated a significant predictive capacity. Recent systematic reviews have established a correlation between ultrasound imaging and difficult direct laryngoscopy. The primary objective of this study was to determine whether the utilization of ultrasonography to examine the upper airway could accurately predict difficult direct laryngoscopy. Methods: This is a prospective observational study including 102 adult patients that required general anesthesia for elective surgery. Preoperatively, clinical airway assessments were performed. Data such as Mallampati-Samsoon grade (MS), upper lip bite test (ULBT), thyromental (TMD) and sternomental distance (SMD), cervical circumference (CC) and the Arné risk index were collected. Ultrasound evaluation was taken at five different levels in two planes, parasagittal and transverse. Therefore, the following measurements were registered: distance from skin to hyoid bone (DSHB), distance from skin to thyrohyoid membrane (DSTHM), distance from skin to epiglottis (DSE), distance from skin to thyroid cartilage (DSTC) and distance from hyoid bone and thyroid cartilage (DHBTC). Patients were divided into two groups based on the difficulty to perform direct laryngoscopy, according to Cormack-Lehane (C-L) classification. Grades I and II were classified as easy laryngoscopy and grades III or IV as difficult. Logistic regression models and the Receiver Operating Characteristic (ROC) curve was employed to determine the diagnostic precision of ultrasound measurements to distinguish difficult laryngoscopy (DL). Results: The following risk score for DL was obtained, DSTHM ≥ 1.60 cm (2 points), DSTC ≥ 0.78 cm (3 points) and gender (2 points for males). The score can range from 0 to 7 points, and showed and AUC (95% CI) of 0.84 (0.74-0.95). A score of 5 points or higher indicates a 34-fold increase in the risk of finding DL (p = 0.0010), sensitivity of 91.67, specificity of 75.56, positive predictive value of 33.33, and negative predictive value of 98.55. Conclusion: The use of ultrasonography combined with classic clinical screening tests are useful tools to predict difficult direct laryngoscopy.

Análisis de la estancia y la morbimortalidad en una unidad de neurocríticos tras la cirugía tumoral cerebral / Analysis of the stay and morbidity and mortality rates in a unit for neurocritical patients following surgery for a brain tumour

Objetivo. Evaluar la asociación entre las variables pre y postoperatorias con estancias superiores al día de ingreso y la morbimortalidad del paciente operado de tumor cerebral durante su estancia en una unidad de cuidados intensivos neurocríticos (UNC). Pacientes y métodos. El estudio retrospectivo incluyó una cohorte de 317 pacientes operados consecutivamente de tumor cerebral por diferentes neurocirujanos e ingresados en la UNC durante un período de tres años (2010-2012). Resultados. El 21,5% (n = 68) de los pacientes tuvo estancias superiores a un día (grupo L), y el 78,5% (n = 249), igual o menores a un día (grupo C). Se evaluó la asociación univariable de los factores de riesgo pre y perioperatorios con la estancia. No hubo diferencias significativas en los datos demográficos, el estado físico según la clasificación de la American Society of Anesthesiologists (ASA), las características anatomopatológicas ni el índice de gravedad tumoral radiológica entre los grupos L y C. Se necesitó intubación traqueal en el 42,6% (n = 29) de los pacientes del grupo L en algún momento del postoperatorio. El 19,1% (n = 13) de los pacientes del grupo L tuvo complicaciones sistémicas y regionales simultáneamente. Conclusiones. Existe una fracción importante de pacientes que tiene una estancia superior a un día en una UNC. Tanto la necesidad de intubación traqueal como la asistencia respiratoria y la aparición de complicaciones sistémicas y regionales pueden determinar estancias superiores a un día en una UNC (AU)

Aim. To evaluate the association between the pre- and post-operative variables with stays in hospital lasting more than one day and the morbidity and mortality rates of patients undergoing surgery for a brain tumour during their stay in a neurocritical intensive care unit (NCU). Patients and methods. The retrospective study, over a period of three years (2010-2012), involving a cohort of 317 patients who consecutively underwent surgical interventions due to brain tumours performed by different neurosurgeons and were hospitalised in the NCU. Results. A total of 21.5% (n = 68) of the patients were hospitalised for more than one day (group L), and 78.5% (n = 249) stayed for one day or less (group S). The univariable association of the pre- and post-operative risks with the length of stay was evaluated. There were no significant differences between groups L and S in terms of the demographic data, the physical status according to the classification of the American Society of Anesthesiologists (ASA), the pathological features or the radiological tumour severity index. Tracheal intubation was required in 42.6% (n = 29) of the patients in group L at some time during the post-operative period. Of the patients in group L, 19.1% (n = 13) had systemic and regional complications simultaneously. Conclusions. An important fraction of patients remain in an NCU for more than one day. The need for both tracheal intubation and respiratory assistance, together with the appearance of systemic and regional complications, can require stays in an NCU for more than one day (AU)

[Analysis of the stay and morbidity and mortality rates in a unit for neurocritical patients following surgery for a brain tumour]. / Análisis de la estancia y la morbimortalidad en una unidad de neurocríticos tras la cirugía tumoral cerebral.

AIM: To evaluate the association between the pre- and post-operative variables with stays in hospital lasting more than one day and the morbidity and mortality rates of patients undergoing surgery for a brain tumour during their stay in a neurocritical intensive care unit (NCU). PATIENTS AND METHODS: The retrospective study, over a period of three years (2010-2012), involving a cohort of 317 patients who consecutively underwent surgical interventions due to brain tumours performed by different neurosurgeons and were hospitalised in the NCU. RESULTS: A total of 21.5% (n = 68) of the patients were hospitalised for more than one day (group L), and 78.5% (n = 249) stayed for one day or less (group S). The univariable association of the pre- and post-operative risks with the length of stay was evaluated. There were no significant differences between groups L and S in terms of the demographic data, the physical status according to the classification of the American Society of Anesthesiologists (ASA), the pathological features or the radiological tumour severity index. Tracheal intubation was required in 42.6% (n = 29) of the patients in group L at some time during the post-operative period. Of the patients in group L, 19.1% (n = 13) had systemic and regional complications simultaneously. CONCLUSIONS: An important fraction of patients remain in an NCU for more than one day. The need for both tracheal intubation and respiratory assistance, together with the appearance of systemic and regional complications, can require stays in an NCU for more than one day.

TITLE: Analisis de la estancia y la morbimortalidad en una unidad de neurocriticos tras la cirugia tumoral cerebral.Objetivo. Evaluar la asociacion entre las variables pre y postoperatorias con estancias superiores al dia de ingreso y la morbimortalidad del paciente operado de tumor cerebral durante su estancia en una unidad de cuidados intensivos neurocriticos (UNC). Pacientes y metodos. El estudio retrospectivo incluyo una cohorte de 317 pacientes operados consecutivamente de tumor cerebral por diferentes neurocirujanos e ingresados en la UNC durante un periodo de tres años (2010-2012). Resultados. El 21,5% (n = 68) de los pacientes tuvo estancias superiores a un dia (grupo L), y el 78,5% (n = 249), igual o menores a un dia (grupo C). Se evaluo la asociacion univariable de los factores de riesgo pre y perioperatorios con la estancia. No hubo diferencias significativas en los datos demograficos, el estado fisico segun la clasificacion de la American Society of Anesthesiologists (ASA), las caracteristicas anatomopatologicas ni el indice de gravedad tumoral radiologica entre los grupos L y C. Se necesito intubacion traqueal en el 42,6% (n = 29) de los pacientes del grupo L en algun momento del postoperatorio. El 19,1% (n = 13) de los pacientes del grupo L tuvo complicaciones sistemicas y regionales simultaneamente. Conclusiones. Existe una fraccion importante de pacientes que tiene una estancia superior a un dia en una UNC. Tanto la necesidad de intubacion traqueal como la asistencia respiratoria y la aparicion de complicaciones sistemicas y regionales pueden determinar estancias superiores a un dia en una UNC.