Ultrasound versus lateral cervical x ray in predicting difficult intubation | ||
| Journal of Recent Advances in Medicine | ||
| Articles in Press, Accepted Manuscript, Available Online from 10 September 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/jram.2025.391066.1285 | ||
| Authors | ||
| Sara M Mahmoud* ; Rasha L El said; Fatma H Ashour | ||
| Anesthesia, ICU and Pain Management | ||
| Abstract | ||
| Background: In obese patients, predicting difficult intubation remains a major challenge, as conventional clinical assessments often fall short. Securing airway is critical for maintaining effective oxygenation and ventilation. Objectives: This study aimed to evaluate and compare the diagnostic performance of upper airway ultrasound (US) and lateral cervical X-ray in predicting difficult intubation among obese patients, in conjunction with clinical assessment, to improve preoperative planning and minimize failed intubation attempts. Methods: This prospective cross-sectional study was conducted on 120 patients aged 21–60 years with a Body Mass Index(BMI) ≥ 32 and Mallampati scores of class III or IV for elective surgeries. Clinical examination, cervical lateral X-ray (measuring Angle E, X2, and X9), and ultrasound measurements (hyomental distance, thyromental distance, and epiglottis-to-vocal cords midpoint) were used to assess predictors of difficult intubation. Results: Ultrasound-based hyomental distance was the most accurate predictor of difficult intubation (Area Under Curve (AUC = 0.92), sensitivity = 75%, specificity = 94.4%) at a cut-off value of ≤ 5.6 cm. Other parameters, including X-ray measurements and additional ultrasound values, showed no statistically significant predictive strength when analyzed independently. Conclusion: Ultrasound, particularly hyomental distance measurement, provides superior accuracy in predicting difficult intubation compared to lateral cervical X-ray. Its non-invasive, accessible, and reliable nature supports its integration into routine airway assessment protocols to enhance patient safety. Keywords: Difficult intubation, airway assessment, upper airway ultrasound, lateral cervical X-ray, hyomental distance. | ||
| Keywords | ||
| Difficult intubation; airway assessment; upper airway ultrasound; lateral cervical X-ray; hyomental distance | ||
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