Airway ultrasound for patients anticipated to have a difficult airway: Perspective for personalized medicine

Abstract

Airway ultrasound allows for precise airway evaluation, particularly for assessing the difficult airway and the potential for front of neck access. Many studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital palpation. However, no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of cricothyroidotomy. This is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision making. The role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is proposed. The goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.

Keywords: Airway ultrasound; Difficult airway; Point-of-care ultrasound; Cricothyroidotomy; Intubation; Mask ventilation

Core Tip: Airway ultrasound may provide a simpler and more accurate prediction of the difficult airway, especially to distinguish difficult mask ventilation from difficult tracheal intubation. Accurate cricothyroid membrane identification may provide a landmark for securing a surgical airway in clinical practice.