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.