Patient-specific Factors Associated with Difficult Mask Ventilation in the Emergency Department

Abstract

Summary: Background: Difficult mask ventilation (DMV) leading to oxygen and ventilation failure can cause complications and fatal consequences in airway management, but has rarely been studied as a primary outcome in the emergency department (ED). This study aimed to determine the incidence and predictors of DMV in the ED. Methods: A specially designed form recording potential risk factors for DMV was designed and subsequently completed by a research nurse and physicians who had performed the procedure for all mask ventilation attempts over a one-year period in the ED of a large hospital in Taipei, Taiwan. Univariate associations between patient characteristics and DMV were measured, and a risk assessment scale was created according to the independent risk factors for DMV ascertained by adjusted regression models. Results: One hundred ten mask ventilation attempts were recorded during the study period. DMV occurred frequently in the ED (45.9% of mask ventilation attempts). Significantly elevated rates of DMV were observed in patients aged 65 years or older those lacking teeth, with sunken cheeks, a double chin or a thick short neck. In adjusted analyses, three easily recognizable predictors, namely lack of teeth, sunken cheeks, and a double chin were found to be independent risk factors for DMV, and accordingly a risk assessment scale- LSD method was made. Conclusion: DMV is a frequent challenge in EDs. An easy-to-use LSD risk scale is created for clinicians to rapidly identify and appropriately manage the risk patients of DMV. Keywords: airway management, emergency physician, endotracheal intubation