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Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways
Published on: April 7, 2023
Evaluation of the upper lip bite test in predicting difficult laryngoscopy
Neelima Myneni1, Anthony M O'Leary, Michael Sandison
1Albany Medical College, Albany, NY 12208, USA.
Journal of Clinical Anesthesia
|April 20, 2010
Summary
The upper lip bite test (ULBT) is not a reliable predictor of difficult laryngoscopy in North American patients. This bedside screening test demonstrated low sensitivity and positive predictive value, and its use is not recommended.
Area of Science:
- Anesthesiology
- Airway Management
- Clinical Prediction
Background:
- Difficult laryngoscopy poses a significant risk during endotracheal intubation.
- Predictive tests are crucial for optimizing airway management strategies.
- The upper lip bite test (ULBT) is a commonly considered bedside screening tool.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the upper lip bite test (ULBT) in predicting difficult laryngoscopy.
- To assess the ULBT's utility as a single preoperative screening test for difficult airways.
Main Methods:
- Prospective, observational outcome study involving 6,882 adult patients across all ASA physical status classifications.
- Preoperative upper lip bite test (ULBT) classification was performed.
- Laryngeal view during endotracheal intubation was assessed using the Cormack & Lehane grade.
Main Results:
- Only 171 patients (2.5%) had ULBT class III, indicative of potential difficult laryngoscopy.
- 173 patients (2.5%) presented with a Cormack & Lehane grade of 3 or 4, signifying difficult laryngoscopy.
- The sensitivity and positive predictive value of the ULBT were low, at 8.1% and 8.2%, respectively.
Conclusions:
- The upper lip bite test (ULBT) is an inadequate predictor of difficult laryngoscopy in this North American patient cohort.
- The ULBT should not be relied upon as the sole bedside screening test for predicting difficult airways.
- Clinical practice guidelines should reconsider the recommendation of the ULBT for routine airway assessment.
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