Test predictivos para intubación orotraqueal difícil en laringoscopia directa. Revisión sistemática

Abstract

Background: The difficult intubation is a clinically relevant scenario in the field of health, due to the impact of its possible negative consequences. Despite a great deal of information on models and prediction scales for difficult intubation, a synthesis of this information has not been carried out. Objective: To determine the prognostic performance of the different predictive tests to identify the existence of difficult intubation in direct laryngoscopy in adults. Materials and methods: A systematic review was carried out, based on the PRISMA, STARD and QUADAS guidelines of publications in English and Spanish, using different databases such as: LILACS, Pubmed, ClinicalKey, ScienceDirect, Scopus, Dynamed, Scielo, EMBASE, Medline , Springer Link, Virtual Health Library, EBSCO, UpToDate, MEDION, Cochrane, and Google Scholar for the past five years. The studies were: prosthetic, cohort and analytical and included an adult population without anatomical malformations of the airway with difficult orotracheal intubation before direct laryngoscopy. Summary measures were used such as: percentages, p-value, relative risk, ods ratio, sensitivity, specificity, positive and negative predictive values. Results: In the 8 articles analyzed, a significant difference was found in Cormack-Lehane grades III/IV, with the tests: upper lip bite (p=0.001), Wilson scale (p=0.001), thyromental height (p =0.002), Mallampati (p=0.009). Most of the predictive tests obtained results with little sensitivity to identify difficult intubation, except for the tests: thyromental height (84.95%) and Mallampati (S: 72.16%). Conclusions: Predictive models are still imperfect as they have a low discriminative capacity. The limitations for this study were: restricted accessibility to articles by economic items for admission. Great variability in studied populations, statistical data by model not evidenced, little information of models in relation to direct laryngoscopy.