TMHT - New Method of Difficult Intubation Prediction

Thyromental Height Test as a New Method for Prediction of Difficult Intubation With Double Lumen Tube

The purpose of this study is to assess the usefulness of the Thyromental Height Test in prediction of difficult intubation using double lumen endotracheal tubes in patients scheduled for elective thoracic procedures.

Study Overview

• Status: Completed
• Conditions: Airway Management; Predictive Value of Tests

Detailed Description

Proper prediction of the occurrence of difficult intubation plays a crucial role in anaesthesiology. For years attempts have been made to develop methods allowing anaesthesiologists to correctly predict the occurrence of difficult intubation. None of the currently used tests and anthropometric measurements present satisfying predictive value. Recent studies show promise in Thyromental Height Test (TMHT), which base on the height between the anterior borders of the mentum and the thyroid cartilage, measured while the patient lies in the supine position with closed mouth, as a single, non-invasive predictor of difficult intubation. Use of double lumen endotracheal tubes during thoracic procedures, due to greater diameter of the tube, may lead to higher occurrence of difficult intubation. That is why, the purpose of this study is to assess the usefulness of the TMHT in prediction of difficult intubation using double lumen endotracheal tubes in patients scheduled for elective thoracic procedures and relate it to other, commonly used predictive tests.

During routine, preoperative anaesthetic visit thyromental height, thyromental distance, sternomental distance and Mallampati scale score are assessed. Then, during direct laryngoscopy and intubation, score in Cormack-Lehane scale and occurrence of difficult intubation are noted.

• Study Type: Observational
• Enrollment (Actual): 237

Contacts and Locations

Study Locations

• Poland
  • Silesia
    • Zabrze, Silesia, Poland, 41-800
      • Samodzielny Publiczny Szpital Kliniczny Nr 1

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Consecutive patients undergoing elective thoracic procedures in university hospital, requiring general anaesthesia, elective direct laryngoscopy and intubation with a double lumen endotracheal tubes.

Description

Inclusion Criteria:

• patients scheduled for elective thoracic procedures, requiring general anaesthesia, direct laryngoscopy and intubation with a Robertshaw type double lumen endotracheal tubes
• consent for participation in the trail
• older than 18

Exclusion Criteria:

• emergency procedures
• visible anatomic abnormalities
• patients scheduled for awake fibre optic intubation
• lack of consent for participation in the trail

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Thyromental height	The height between the anterior border of the thyroid cartilage (on the thyroid notch just between the 2 thyroid laminae) and the anterior border of the mentum (on the mental protuberance of the mandible), in supine position with mouth closed, measured with a depth gauge, measured during routine preoperative anaesthetic visit.	immediate

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Thyromental distance	The distance between the thyroid prominence and the most anterior part of the mental prominence of the mandible, measured with a standard centigrade ruler as the distance in centimetres with the patient in supine position, head fully extended, mouth closed, during routine preoperative anaesthetic visit.	immediate
Sternomental distance	The distance in centimetres between the superior border of the manubrium sterni and the bony point of the mentum, with the patient in supine position, head fully extended, mouth closed, measured with a standard centigrade ruler, during routine preoperative anaesthetic visit.	immediate
score in modified Mallampati test	The oropharyngeal view is assessed in sitting position, mouth maximally opened, tongue protruded, without phonation, measured during routine preoperative anaesthetic visit.	immediate
score in Cormack-Lehane scale	During direct laryngoscopy the patient is graded in Cormack-Lehane Scale by the laryngoscopist.	immediate

Collaborators and Investigators

• Sponsor: Medical University of Silesia
• Investigators: Study Chair: Hanna Misiołek, MD PhD, School of Medicine with the Division of Dentistry in Zabrze. Medical University of Silesia. Department of Anaesthesiology and Critical Care.

Publications and helpful links

General Publications

• Palczynski P, Bialka S, Misiolek H, Copik M, Smelik A, Szarpak L, Ruetzler K. Thyromental height test as a new method for prediction of difficult intubation with double lumen tube. PLoS One. 2018 Sep 13;13(9):e0201944. doi: 10.1371/journal.pone.0201944. eCollection 2018.

Study record dates

Study Major Dates

• Study Start: September 1, 2016
• Primary Completion (Actual): January 1, 2017
• Study Completion (Actual): January 1, 2017

Study Registration Dates

• First Submitted: November 30, 2016
• First Submitted That Met QC Criteria: December 7, 2016
• First Posted (Estimate): December 9, 2016

Study Record Updates

• Last Update Posted (Estimate): January 31, 2017
• Last Update Submitted That Met QC Criteria: January 29, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Keywords: difficult intubation; thyromental height
• Other Study ID Numbers: TMHT-01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO