Predictors of combined difficulty with mask ventilation and direct laryngoscopy

Predictors of difficult/impossible mask ventilation	Modified and additional predictors
Mallampati grade 3 to 4 Decreased mandibular protrusion Presence of beard Obesity (BMI ≥30) Male sex OSA*	Age ≥46 years Presence of teeth Neck radiation changes or a neck mass Thick or obese neck Unstable neck or decreased neck extension Decreased thyromental distance

The association of DMV with difficult DL includes many predictors of DMV and impossible mask ventilation, as well as the modified and additional factors, listed in italics. At least five predictors (risk factors) total should be present for a reasonably high probability of both DMV and difficult DL. Class III patients (five risk factors) comprise 5 percent of all DMV+DL cases, and patients from Classes IV (six risk factors) and V (7 to 11 risk factors) comprise the largest group (85 percent) of these cases.

DL: direct laryngoscopy; BMI: body mass index; OSA: obstructive sleep apnea; DMV: difficult mask ventilation; CPAP: continuous positive airway pressure; BiPAP: bilevel positive airway pressure.
* Moderate-to-severe OSA associated with the use of CPAP/BiPAP or a history of OSA surgery.

Adapted from: Kheterpal S, Healy D, Aziz MF, et al. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiology 2013; 119:1360.

Courtesy of Dr. Vladimir Nekhendzy.

Graphic 109112 Version 4.0

خرید پکیج

Predictors of combined difficulty with mask ventilation and direct laryngoscopy