Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital

Useful Ultrasonographic Parameters to Predict Difficult Laryngoscopy and Difficult Tracheal Intubation-A Systematic Review and Meta-Analysis

Research output: Contribution to journalJournal articleResearchpeer-review


  1. Novel Anti-inflammatory Treatments in Cirrhosis. A Literature-Based Study

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis-Status and Recent Advances

    Research output: Contribution to journalReviewResearchpeer-review

  3. Intradermal Tests With Drugs: An Approach to Standardization

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Infrared flashing light through the cricothyroid membrane to guide flexible bronchoscopic tracheal intubation

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Exploring the limits of prolonged apnoea with high-flow nasal oxygen: an observational study

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Anesthesiologists’ airway management expertise: Identifying subjective and objective knowledge gaps

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Ultrasound identification of the cricothyroid membrane: the new standard in preparing for front-of-neck airway access

    Research output: Contribution to journalEditorialResearchpeer-review

  5. A marking of the cricothyroid membrane with extended neck returns to correct position after neck manipulation and repositioning

    Research output: Contribution to journalJournal articleResearchpeer-review

  • Sara H Gomes
  • Ana M Simões
  • Andreia M Nunes
  • Marta V Pereira
  • Wendy H Teoh
  • Patrício S Costa
  • Michael S Kristensen
  • Pedro M Teixeira
  • José Miguel Pêgo
View graph of relations

Unexpected difficult airway management can cause significant morbidity and mortality in patients admitted for elective procedures. Ultrasonography is a promising tool for perioperative airway assessment, nevertheless it is still unclear which sonographic parameters are useful predictors of difficult laryngoscopy and tracheal intubation. To determine the ultrasonographic predictors of a difficult airway that could be applied for routine practice, a systematic review and meta-analysis was conducted. Literature search was performed on PubMED, Web of Science and Embase using the selected keywords. Human primary studies, published in English with the use of ultrasonography to prediction of difficult laryngoscopy or tracheal intubation were included. A total of 19 articles (4,570 patients) were analyzed for the systematic review and 12 articles (1,141 patients) for the meta-analysis. Standardized mean differences between easy and difficult laryngoscopy groups were calculated and the parameter effect size quantified. A PRISMA methodology was used and the critical appraisal tool from Joanna Briggs Institute was applied. Twenty-six sonographic parameters were studied. The overall effect of the distance from skin to hyoid bone (p = 0.02); skin to epiglottis (p = 0.02); skin to the anterior commissure of vocal cords (p = 0.02), pre-epiglottis space to distance between epiglottis and midpoint between vocal cords (p = 0.01), hyomental distance in neutral (p < 0.0001), and extended (p = 0.0002) positions and ratio of hyomental distance in neutral to extended (p = 0.001) was significant. This study shows that hyomental distance in the neutral position is the most reliable parameter for pre-operative airway ultrasound assessment. The main limitations of the study are the small sample size, heterogeneity of studies, and absence of a standardized ultrasonographic evaluation method [Registered at International prospective register of systematic reviews (PROSPERO): number 167931].

Original languageEnglish
JournalFrontiers in Medicine
Pages (from-to)671658
Publication statusPublished - 2021

    Research areas

  • airway ultrasound assessment, prediction of difficult intubation, prediction of difficult laryngoscopy, ultrasound predictors of difficult intubation, ultrasound predictors of difficult laryngoscopy

ID: 66398600