Overview of Airway Assessment
Checking a patient’s airway quickly and carefully is very important for those who need advanced help with their breathing. There are several reasons why someone might need help with their airway, including not getting enough oxygen, difficulty breathing, or a blocked airway. What method the doctor uses to help the patient depends on why the patient is having trouble, how severe their condition is, and the doctor’s skills and the environment.
Helping a patient with their airway can be done in ways that are either noninvasive (not requiring the doctor to go deep inside the body) or invasive (requiring the doctor to go inside the body). Noninvasive help can include giving extra oxygen, using a mask with a bag attached (bag-valve-mask ventilation), inserting tubes above the vocal cords (supraglottic airways), or using a machine to add pressure to the patient’s breathing (noninvasive positive-pressure ventilation). Invasive help includes inserting a tube into the windpipe (endotracheal intubation), creating an opening in the neck to help with breathing (cricothyroidotomy or tracheostomy).
Patients who need help with their airway have to be checked for a possible “difficult airway.” This condition could make regular mask use difficult or increase the risk of failing to insert a tube. An “failed airway” occurs when a tube isn’t successfully inserted after three attempts by a trained medical professional.
Getting detailed information about the patient’s prior airway issues helps the doctor decide if the patient had problems with their airway in the past. Many different diseases can make the airway difficult to manage. Additionally, lung diseases like asthma, pneumonia, or chronic obstructive pulmonary disease can affect the patient’s ability to get enough oxygen and breathe out enough carbon dioxide.
Anatomy and Physiology of Airway Assessment
Before a doctor attempts to place a breathing tube, known as intubation, they need to evaluate potential difficulties that might arise during the procedure.
Medical practitioners consider various factors that potentially make bag-valve-mask ventilation (assisted breathing) difficult. This might include facial hair, being overweight, lack of teeth (edentulousness), being older in age, or having a history of snoring. A quick visual check can usually highlight these factors. If you have dentures, they would typically need to be removed when intubation is carried out, but may be left in place for other forms of breathing assistance.
Doctors usually follow a step-by-step approach to analyze how easy or hard it will be to place the breathing tube. This process consists of several quick and simple checks.
The patient’s mouth opening is checked using fingers as a simple measuring tool. Ideally, the opening of the mouth in adults should be around 4 centimeters or roughly three to four fingers wide. The chin-to-neck distance should also be around three to four fingers. This assessment gives the doctor an indication of how effectively they will be able to visualize important structures during intubation.
The doctors might also request patients to open their mouth while sitting upright to see how much the tongue is blocking the back of the throat. They use something known as the Mallampati classification system to determine how hard intubation might be. The harder it is to see the back of the throat (glottis) because of the tongue, the higher the Mallampati score and the more challenging the intubation process.
Here’s how the Mallampati system categorizes throat visibility:
* Class I: Doctors can see the entire back of the mouth including the side pillars down to their base
* Class II: Top of the side pillars and most of the uvula (dangly bit at back of the mouth) are visible
* Class III: Only the hard and soft parts of the roof of the mouth are visible
* Class IV: Only the hard part of the roof of the mouth is visible
A patient’s neck movement also plays a part in assessing the easiness of intubation. The best position for intubation is referred to as the “sniffing position,” requiring limited neck bending and head leaning. Neck movement can be affected by items such as a neck brace or structural changes, like a fracture, dislocation, or arthritis.
Doctors can also ask patients to move their lower jaw forward or bite their upper lip to understand the maneuverability of the lower jaw. This helps the practitioner anticipate any obstacles during intubation. The resulting classification is as follows:
* Grade 1: the patient can fully cover the upper lip with the lower teeth
* Grade 2: the patient can partially cover the upper lip with the lower teeth
* Grade 3: the patient can’t reach the upper lip with the lower teeth.
Why do People Need Airway Assessment
If you’re having trouble breathing, it means your body isn’t getting enough oxygen. This can put a lot of strain on your body and can potentially lead to a serious condition called respiratory failure. Doctors need to carefully check your breathing if you’re in distress. They’ll be looking out for signs that your body is working too hard to get oxygen.
When your body isn’t getting enough oxygen, it can affect your brain. This could make you feel anxious or confused, or it might even make you lose consciousness. If your breathing is irregular or too fast or too slow, or you’re using extra muscles to breathe, it could be a sign that your body is in distress. One visible sign of this is cyanosis, which is when your skin or lips turn blue due to lack of oxygen.
When a Person Should Avoid Airway Assessment
There is no real reason why a doctor cannot check a person’s airway. This means that assessing how well you breathe and how open your airways are can be done safely for everyone.
Equipment used for Airway Assessment
Choosing the right tool to help a patient breathe is very important for managing their airway.
One simple technique is face mask ventilation, where a mask provides oxygen to the patient before an airway device is placed. Another method is noninvasive positive-pressure ventilation, which gives the airway positive pressure support without the need for a tube down the windpipe. The patient can be put on a continuous positive airway pressure (CPAP) device or a bilevel positive airway pressure (BIPAP) device. This method works best for cooperative patients who can protect their own airway and are still able to breathe on their own. However, we have to be careful using this method on patients who have low blood volume and low blood pressure. The extra pressure might cause their condition to worsen. Also, if the patient’s breathing is very weak or non-existent, if they can’t cough or swallow properly, if they are confused, if they have severe face or skull damage, major nosebleed, or bubble-like structures in the lung, we should not use CPAP or BIPAP. In these cases, we need to place a tube down their windpipe to help them breathe, a method called endotracheal intubation.
There are also devices known as supraglottic airways that go into the throat and help ventilation from above the vocal cords (the glottis). The most common type of such a device is called a laryngeal mask airway (LMA). This type of device might be used in cases where face mask ventilation or intubation are difficult, and we need something to help the patient breathe or enable intubation.
Endotracheal tubes are devices that are inserted through the nose or mouth to supply oxygen and ventilation. The end of this tube is positioned in the middle of the windpipe.
How is Airway Assessment performed
Checking a patient’s airway is an important part of medical care, especially for those about to have surgery, those receiving trauma care, or those under critical care. Over time, health professionals have developed various techniques and methods for this important job.
One common way to check a patient’s airway is what’s called a predictive physical examination. This typically involves measuring certain features of the patient’s face and neck, such as the distance between the thyroid cartilage and the mandible (thyromental distance), or the distance between the sternum and the mandible (sternomental distance). The doctor might also look at neck movement and use something called the Mallampati score, which is a way of judging how easy it will be to place a breathing tube based on how much of the mouth’s back wall a person can see with their mouth open wide and tongue sticking out. These methods are helpful but they’re not perfect as they are based on the healthcare professional’s judgement and experience, and can sometimes be off the mark.
Medical technology keeps getting better and is providing new ways to check a person’s airway. For instance, ultrasound – a safe and painless method that uses sound waves to create images of the inside of the body – is proving to be a very handy tool for looking at the breathing passages. It gives real-time images that can be especially helpful for predicting when putting in a breathing tube might be difficult. Also, video laryngoscopy, which involves using a tool with a video camera to look directly at the voice box, has improved doctors’ ability to see the airway, thereby helping them successfully place breathing tubes.
Artificial intelligence (AI) and machine learning – where computer systems learn and improve from experience – are also being used to check airways. Algorithms, which are complex sets of step-by-step instructions, can combine lots of different patient details to predict outcomes more accurately than traditional methods. However, this technology is still new, and more studies are needed to figure out the best ways to use it. Using a special type of video camera to look at the airway while a patient is still awake has also been shown to help doctors assess how risky it might be to operate on a person’s airway.
What Else Should I Know About Airway Assessment?
Simply put, determining how easy or difficult it might be to place a breathing tube into someone’s windpipe can be predicted with certain tools. This process, known as airway assessment, is personalized for every patient and considers many factors. Factors can include the patient’s position, the urgency of the situation, available tools, and the doctor’s skills and experience. All these elements will be considered in choosing the best method to assess the patient’s breathing pathway.
In summary, evaluating a patient’s airway is a mix of clinical judgment, physical exams, and the use of cutting-edge tools. While traditional methods remain important, newer technologies like ultrasound and video machines that let the doctor see inside the throat are useful and can be more accurate and efficient. There are also AI-assisted methods that can help. It’s important to embrace these new technologies, keeping in mind they also have their limitations. Using them wisely can greatly increase patient safety and improve the results of their treatment.
