The baseline risk for difficult airway (8-11%) and severe complications (38%) is high in all critically ill patients. Difficult airway greatly increases the risk of severe complcations during intubation (30-35% vs 50-60%). Scoring systems for elective surgery therefore seriously underestimate risk in this cohort.
Consider the MACOCHA Score to identify patients at paritcularly high risk and plan accordingly.
It is worth noting that Mallampati score does the heavy lifting in prediction difficult intubations (Identified 51/82 alone, compared to 62/82 with the full score).
Score
| Factor | Score |
|---|---|
| Patient factors | |
| Mallampati III or IV | 5 |
| Obstructive Sleep Apnoea | 2 |
| Restricted neck movement | 1 |
| Mouth opening <3cm | 1 |
| Pathology factors | |
| Coma | 1 |
| Severe hypoxaemia <80% | 1 |
| Operator factors | |
| Non-anaesthetist | 1 |
Interpretation
Incidence of difficult airway or airway complication by score:
| Score | Risk |
|---|---|
| 1-2 | 2% |
| 3-4 | 5% |
| 4-5 | 25% |
| 6-7 | 45% |
| 8-9 | 50% |
| 10-12 | 100% |