Point‐of‐care ultrasound of the upper airway in difficult airway management: a systematic review and meta‐analysis*
Authors' conclusion
Upper airway point-of-care ultrasound may improve prediction of difficult airways; its use is associated with improved first pass success in percutaneous tracheostomy.
Study context
- Population
- Patients undergoing upper airway POCUS assessment for difficult airway prediction and management
- Participants
- 10,580 patients · 60 studies
- Comparison
- Upper airway POCUS parameters for prediction of difficult airways
- Outcome
- Diagnostic utility of upper airway POCUS parameters in predicting difficult airways
Methodological detailsrandomised controlled trials, observational studies and case series (>5 cases), narrative synthesis
- Randomised controlled trials, observational studies and case series (>5 cases)
- Narrative synthesis
Pooled result
As reported in the abstract
Prediction of difficult laryngoscopy and difficult tracheal intubation
| Group | AUC (difficult laryngoscopy) | AUC (difficult intubation; highest) | Sensitivity (difficult laryngoscopy) | Sensitivity (difficult intubation; highest) | Sensitivity (difficult intubation) | Specificity (difficult laryngoscopy) | Specificity (difficult intubation; highest) | Specificity (difficult intubation) |
|---|---|---|---|---|---|---|---|---|
| Skin-to-vocal-cords distance | 0.87 (95%CI 0.78-0.89) | — not stated in the abstract | 0.84 (95%CI 0.74-0.91) | — not stated in the abstract | — not stated in the abstract | 0.81 (95%CI 0.61-0.92) | — not stated in the abstract | — not stated in the abstract |
| Skin-to-epiglottis distance | — not stated in the abstract | — not stated in the abstract | — not stated in the abstract | 0.80 (95%CI 0.74-0.85) | — not stated in the abstract | — not stated in the abstract | 0.86 (95%CI 0.74-0.91) | — not stated in the abstract |
| Skin-to-hyoid distance | — not stated in the abstract | 0.86 (95% CI 0.73-0.92) | — not stated in the abstract | — not stated in the abstract | 0.78 (95%CI 0.60-0.89) | — not stated in the abstract | — not stated in the abstract | 0.81 (95%CI 0.63-0.91) |
AUC (difficult laryngoscopy)
Skin-to-vocal-cords distance0.87 (95%CI 0.78-0.89)
Skin-to-epiglottis distance— not stated in the abstract
Skin-to-hyoid distance— not stated in the abstract
AUC (difficult intubation; highest)
Skin-to-vocal-cords distance— not stated in the abstract
Skin-to-epiglottis distance— not stated in the abstract
Skin-to-hyoid distance0.86 (95% CI 0.73-0.92)
Sensitivity (difficult laryngoscopy)
Skin-to-vocal-cords distance0.84 (95%CI 0.74-0.91)
Skin-to-epiglottis distance— not stated in the abstract
Skin-to-hyoid distance— not stated in the abstract
Sensitivity (difficult intubation; highest)
Skin-to-vocal-cords distance— not stated in the abstract
Skin-to-epiglottis distance0.80 (95%CI 0.74-0.85)
Skin-to-hyoid distance— not stated in the abstract
Sensitivity (difficult intubation)
Skin-to-vocal-cords distance— not stated in the abstract
Skin-to-epiglottis distance— not stated in the abstract
Skin-to-hyoid distance0.78 (95%CI 0.60-0.89)
Specificity (difficult laryngoscopy)
Skin-to-vocal-cords distance0.81 (95%CI 0.61-0.92)
Skin-to-epiglottis distance— not stated in the abstract
Skin-to-hyoid distance— not stated in the abstract
Specificity (difficult intubation; highest)
Skin-to-vocal-cords distance— not stated in the abstract
Skin-to-epiglottis distance0.86 (95%CI 0.74-0.91)
Skin-to-hyoid distance— not stated in the abstract
Specificity (difficult intubation)
Skin-to-vocal-cords distance— not stated in the abstract
Skin-to-epiglottis distance— not stated in the abstract
Skin-to-hyoid distance0.81 (95%CI 0.63-0.91)
— not stated in the abstract
Further pooled results
First pass success in percutaneous tracheostomy
| OR for first pass success (95% CI) | ||
|---|---|---|
| UltrasoundLow-moderate certainty of evidence | 3.9 (2.1–71) | |
| 0.050.21520OR for first pass success (log scale) |
| Outcome | OR for improved cricothyroid membrane identification (95% CI) | |
|---|---|---|
| Cricothyroid membrane identificationUltrasound vs Palpation · moderate-high certainty of evidence | 3.61 (2.20–5.92) | |
| 0.20.5125OR for improved cricothyroid membrane identification (log scale) |
| Outcome | Skin-to-epiglottis distance | Skin-to-hyoid distance |
|---|---|---|
| Prediction of difficult tracheal intubationSkin-to-hyoid: highest AUROC, moderate certainty of evidence | ||
| Sensitivity | 0.80 (95%CI 0.74-0.85) | 0.78 (95%CI 0.60-0.89) |
| Specificity | 0.86 (95%CI 0.74-0.91) | 0.81 (95%CI 0.63-0.91) |
| AUC | — not stated in the abstract | 0.86 (95% CI 0.73-0.92) |
— not stated in the abstract
- Prediction of difficult tracheal intubation: skin-to-epiglottis: highest sensitivity and specificity, high certainty of evidence
Difficult facemask ventilation (narrative synthesis)
- Increased tongue thickness associated with increased incidence of difficult airway
Original publication
Point‐of‐care ultrasound of the upper airway in difficult airway management: a systematic review and meta‐analysis*. Anaesthesia. Published 2 September 2025. doi:10.
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