Prediction of difficult airways in elderly patients using bedside ultrasound: a prospective single-blind...

This prospective, single-blind observational study evaluated the predictive performance of selected ultrasound airway predictors and a combined prediction model for difficult laryngoscopy and difficult intubation in elderly patients. A total of 242 elderly patients scheduled for elective surgery under general anaesthesia with endotracheal intubation were enrolled. During the preanaesthesia phase, demographic information, classic clinical airway assessments, and ultrasound predictors were collected. The ultrasound predictors included mandibular condylar translation distance (MCTD), tongue thickness (TT), tongue volume (TV), hyomental distance in the extended position (HMDe), and hyomental distance ratio (HMDR). After anaesthesia induction, laryngoscopic views were graded, and intubation difficulty was scored. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves. Least absolute shrinkage and selection operator (LASSO) logistic regression with tenfold cross-validation was used for variable selection. A multivariable logistic regression model was constructed for predicting difficult laryngoscopy, visualized as a nomogram, and internally validated using bootstrap resampling with 1000 repetitions. The final analysis included 226 elderly patients, 44 (19.5%) of whom experienced difficult laryngoscopy and 25 (11.1%) of whom experienced difficult intubation. MCTD showed the highest area under the ROC curve (AUC) among individual predictors for both difficult laryngoscopy (AUC 0.89; 95% CI: 0.84-0.94; P < 0.001) and difficult intubation (AUC 0.91; 95% CI: 0.86-0.97; P < 0.001). For difficult laryngoscopy, LASSO selected MCTD, HMDR, IID, TMD, MMS, and sex. In the multivariable model, lower MCTD, HMDR, IID, and male sex were independently associated with increased odds of difficult laryngoscopy. The six-predictor model showed an apparent AUC of 0.944 (95% CI: 0.914-0.974) and an optimism-corrected AUC of 0.924 (95% CI: 0.885-0.958). Several ultrasound measurements showed diagnostic value for predicting difficult laryngoscopy and difficult intubation in elderly patients. Mandibular condylar translation distance demonstrated the strongest individual ultrasound performance and remained an independent predictor of difficult laryngoscopy in the multivariable model. A combined model incorporating ultrasound and clinical airway parameters may provide individualized risk estimation for difficult laryngoscopy.Trial registration Retrospectively registered at www.chictr.org.cn (ChiCTR2300076196), 27 September 2023.