Facial Analysis to Classify Difficult Intubation
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 64 |
| Updated: | 7/20/2018 |
| Start Date: | May 2012 |
| End Date: | June 2019 |
| Contact: | Scott Segal, MD, MHCM |
| Email: | bsegal@wakehealth.edu |
| Phone: | (336) 716-7084 |
Comparison of a Computerized Image Analysis to Conventional Airway Examination Techniques to Predict Difficult Endotracheal Intubation
The aim of this project is to develop a computer algorithm that can accurately predict how
easy or difficult it is to intubate a patient based upon digital photographs from three
different perspectives. Such an application can provide a consistent, quantitative measure of
intubation difficulty by analyzing facial features in captured photographs - features which
have previously been shown to correlate with how easy or how hard it would be to perform the
intubation procedure. This is in contrast to established subjective protocols that also serve
to predict intubation difficulty, albeit with lower accuracy. A digital application has the
potential to decrease potential complications related to intubation difficulty and increase
patient safety.
easy or difficult it is to intubate a patient based upon digital photographs from three
different perspectives. Such an application can provide a consistent, quantitative measure of
intubation difficulty by analyzing facial features in captured photographs - features which
have previously been shown to correlate with how easy or how hard it would be to perform the
intubation procedure. This is in contrast to established subjective protocols that also serve
to predict intubation difficulty, albeit with lower accuracy. A digital application has the
potential to decrease potential complications related to intubation difficulty and increase
patient safety.
Both control and experimental cohorts will be recruited in this study. In order to drive
clinical acceptance of this technique, the investigators will need to study and then
demonstrate applicability to all patients regardless of race or gender. This will require the
recruitment of a control population of patients who have been demonstrated at surgery to be
easy to intubate. Such patients are in relative abundance. The experimental group will
consist of patients who are found at surgery to be difficult to intubate. Patients are
defined as easy to intubate if their anesthetic record described a single attempt with a
Macintosh 3 blade resulting in a grade 1 laryngoscopic view (full exposure of the vocal
cords). Difficult intubation was defined by at least one of: more than one attempt by an
operator with at least one year of anesthesia experience, grade 3 or 4 laryngoscopic view on
a 4 point scale, 5 need for a second operator, or non-elective use of an alternative airway
device such as a bougie, fiberoptic bronchoscope or intubating laryngeal mask airway.
The primary purpose of the study is to develop algorithms capable of discriminating patients
who are likely to be difficult to intubate from those who are likely to be easy to intubate
based on facial appearance. The primary analysis is the demonstration of statistical
significance in the ability of the derived algorithms to determine successfully whether a
subject was easy or difficult to intubate. A secondary analysis is the demonstration of a
statistical difference in performance between the derived algorithms versus conventional
airway assessment tests.
clinical acceptance of this technique, the investigators will need to study and then
demonstrate applicability to all patients regardless of race or gender. This will require the
recruitment of a control population of patients who have been demonstrated at surgery to be
easy to intubate. Such patients are in relative abundance. The experimental group will
consist of patients who are found at surgery to be difficult to intubate. Patients are
defined as easy to intubate if their anesthetic record described a single attempt with a
Macintosh 3 blade resulting in a grade 1 laryngoscopic view (full exposure of the vocal
cords). Difficult intubation was defined by at least one of: more than one attempt by an
operator with at least one year of anesthesia experience, grade 3 or 4 laryngoscopic view on
a 4 point scale, 5 need for a second operator, or non-elective use of an alternative airway
device such as a bougie, fiberoptic bronchoscope or intubating laryngeal mask airway.
The primary purpose of the study is to develop algorithms capable of discriminating patients
who are likely to be difficult to intubate from those who are likely to be easy to intubate
based on facial appearance. The primary analysis is the demonstration of statistical
significance in the ability of the derived algorithms to determine successfully whether a
subject was easy or difficult to intubate. A secondary analysis is the demonstration of a
statistical difference in performance between the derived algorithms versus conventional
airway assessment tests.
Inclusion Criteria:
- Patients requiring endotracheal intubation
- Patients consenting to acquisition of photographic images of the head and neck
Exclusion Criteria:
- Patients who had undergone head or neck surgery
- Patients in whom central venous catheters or other interventions that prevent full
view of the features of the face in frontal and profile views
- Patients who were neither easy nor difficult to intubate by our criteria
We found this trial at
1
site
Winston-Salem, North Carolina 27157
Principal Investigator: Scott Segal, MD, MHCM
Phone: 336-716-4497
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