Airway Management in High-Altitude Patients With Deep Odontogenic Infection During the Perioperative Period.
A quantifiable preoperative airway evaluation protocol facilitates early recognition of difficult airways and the standardized implementation of perioperative airway care.
To evaluate the application of preoperative three-dimensional computed tomography airway reconstruction images to predicting difficult airway in high-altitude patients with deep odontogenic infection (DOI).
This retrospective cohort study enrolled subjects hospitalized for DOI in the Department of Oral and Maxillofacial Surgery, Xizang Autonomous Region People's Hospital. Patients were excluded if they received intubation/tracheotomy before computed tomography, had diseases altering airway anatomy, or prior maxillofacial radiotherapy/surgery.
The primary predictor variables were upper airway morphological parameters, including airway volume, midsagittal area, minimal cross-sectional area, minimum lateral diameter, minimum anteroposterior diameter, pharyngeal soft tissue thickness, and airway midline deviation distance.
The main outcome variable was airway difficulty. Subjects were grouped into difficult airway and nondifficult airway groups, defined as patients requiring preoperative tracheotomy or postoperative mechanical ventilation after surgery versus those receiving neither intervention, respectively.
The covariates included age, sex, hypertension, diabetes mellitus, alcohol consumption, and smoking status.
Morphological parameters between the difficult and nondifficult airway groups were compared by independent t-test, while qualitative data were analyzed using chi-square test. Multivariate binary logistic regression was performed to identify independent predictors of difficult airway. P < .05 indicated statistical significance.
The sample included 56 subjects with a mean age of 36.7 ± 16.2 years and 26/56 (46.4%) were male. The logistic regression analysis showed that the lateral diameter of the oropharynx at the minimal cross-section (Oro-LAT) (P = .03), the minimal cross-sectional airway area of the hypopharynx (Hypo-Msa) (P = .002), and the airway midline deviation distance at the anteroinferior point of the 2nd cervical vertebrae (C2-Md) (P = .003) were statistically significantly related to difficult airway. Operative time, hospital stay, and total hospitalization costs were statistically significantly greater in the difficult airway group versus the nondifficult airway group (P < .01).
For high-altitude patients with DOI, reduced Oro-LAT, and Hypo-Msa, increased C2-Md are important morphological indicators of difficult airways. Patients with these airway changes tend to require tracheotomy or mechanical ventilation, accompanied by longer operation time, prolonged hospital stay, and higher medical costs.
To evaluate the application of preoperative three-dimensional computed tomography airway reconstruction images to predicting difficult airway in high-altitude patients with deep odontogenic infection (DOI).
This retrospective cohort study enrolled subjects hospitalized for DOI in the Department of Oral and Maxillofacial Surgery, Xizang Autonomous Region People's Hospital. Patients were excluded if they received intubation/tracheotomy before computed tomography, had diseases altering airway anatomy, or prior maxillofacial radiotherapy/surgery.
The primary predictor variables were upper airway morphological parameters, including airway volume, midsagittal area, minimal cross-sectional area, minimum lateral diameter, minimum anteroposterior diameter, pharyngeal soft tissue thickness, and airway midline deviation distance.
The main outcome variable was airway difficulty. Subjects were grouped into difficult airway and nondifficult airway groups, defined as patients requiring preoperative tracheotomy or postoperative mechanical ventilation after surgery versus those receiving neither intervention, respectively.
The covariates included age, sex, hypertension, diabetes mellitus, alcohol consumption, and smoking status.
Morphological parameters between the difficult and nondifficult airway groups were compared by independent t-test, while qualitative data were analyzed using chi-square test. Multivariate binary logistic regression was performed to identify independent predictors of difficult airway. P < .05 indicated statistical significance.
The sample included 56 subjects with a mean age of 36.7 ± 16.2 years and 26/56 (46.4%) were male. The logistic regression analysis showed that the lateral diameter of the oropharynx at the minimal cross-section (Oro-LAT) (P = .03), the minimal cross-sectional airway area of the hypopharynx (Hypo-Msa) (P = .002), and the airway midline deviation distance at the anteroinferior point of the 2nd cervical vertebrae (C2-Md) (P = .003) were statistically significantly related to difficult airway. Operative time, hospital stay, and total hospitalization costs were statistically significantly greater in the difficult airway group versus the nondifficult airway group (P < .01).
For high-altitude patients with DOI, reduced Oro-LAT, and Hypo-Msa, increased C2-Md are important morphological indicators of difficult airways. Patients with these airway changes tend to require tracheotomy or mechanical ventilation, accompanied by longer operation time, prolonged hospital stay, and higher medical costs.