Point‐of‐care ultrasound of the upper airway in difficult airway management: a systematic review and meta‐analysis*
Bibliographic record
Abstract
INTRODUCTION: The utility of bedside screening tests for the prediction of difficult airways is limited. There is growing interest in the role of point-of-care-ultrasound in airway assessment and management. This systematic review and meta-analysis aimed to determine the diagnostic utility and clinical application of various upper airway point-of-care-ultrasound parameters in the prediction of difficult airways. METHODS: We searched databases for randomised controlled trials, observational studies and case series with more than five cases. RESULTS: In total, 60 studies involving 10,580 patients, evaluating 58 parameters were included. For difficult facemask ventilation, a narrative synthesis showed that increased tongue thickness was associated with an increased incidence of a difficult airway. For prediction of difficult laryngoscopy, the sensitivity, specificity and area under the receiver operator characteristic curve (AUROC) for distance from-skin-to-vocal-cords were 0.84 (95%CI 0.74-0.91), 0.81 (95%CI 0.61-0.92) and 0.87 (95%CI 0.78-0.89), respectively (high certainty of evidence). For prediction of difficult tracheal intubation, distance from skin-to-epiglottis had the highest sensitivity (0.80 (95%CI 0.74-0.85)) and specificity (0.86 (95%CI 0.74-0.91)) (high certainty of evidence), while distance from skin-to-hyoid had the highest AUROC of 0.86 (95% CI 0.73-0.92), with a sensitivity and specificity of 0.78 (95%CI 0.60-0.89) and 0.81 (95%CI 0.63-0.91), respectively (moderate certainty of evidence). Ultrasound use was associated with higher first pass success in percutaneous tracheostomy (odds ratio (95%CI) 3.9 (2.1-71), (low-moderate certainty of evidence)) and improved cricothyroid membrane identification compared with palpation (odds ratio (95%CI) 3.61 (2.20-5.92) (moderate-high certainty of evidence)). DISCUSSION: Upper airway point-of-care ultrasound may improve prediction of difficult airways; its use is associated with improved first pass success in percutaneous tracheostomy. Future research should focus on evaluating its use in combination with a focused history and standard bedside examination tests, and in at-risk patient populations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.050 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.027 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".