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Choi SJ, Kim DK, Kim BS, Cho M, Jeong J, Jo YH, Song KJ, Kim YJ, Kim S. Mask R-CNN based multiclass segmentation model for endotracheal intubation using video laryngoscope. Digit Health 2023; 9:20552076231211547. [PMID: 38025115 PMCID: PMC10631336 DOI: 10.1177/20552076231211547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Endotracheal intubation (ETI) is critical to secure the airway in emergent situations. Although artificial intelligence algorithms are frequently used to analyze medical images, their application to evaluating intraoral structures based on images captured during emergent ETI remains limited. The aim of this study is to develop an artificial intelligence model for segmenting structures in the oral cavity using video laryngoscope (VL) images. Methods From 54 VL videos, clinicians manually labeled images that include motion blur, foggy vision, blood, mucus, and vomitus. Anatomical structures of interest included the tongue, epiglottis, vocal cord, and corniculate cartilage. EfficientNet-B5 with DeepLabv3+, EffecientNet-B5 with U-Net, and Configured Mask R-Convolution Neural Network (CNN) were used; EffecientNet-B5 was pretrained on ImageNet. Dice similarity coefficient (DSC) was used to measure the segmentation performance of the model. Accuracy, recall, specificity, and F1 score were used to evaluate the model's performance in targeting the structure from the value of the intersection over union between the ground truth and prediction mask. Results The DSC of tongue, epiglottis, vocal cord, and corniculate cartilage obtained from the EfficientNet-B5 with DeepLabv3+, EfficientNet-B5 with U-Net, and Configured Mask R-CNN model were 0.3351/0.7675/0.766/0.6539, 0.0/0.7581/0.7395/0.6906, and 0.1167/0.7677/0.7207/0.57, respectively. Furthermore, the processing speeds (frames per second) of the three models stood at 3, 24, and 32, respectively. Conclusions The algorithm developed in this study can assist medical providers performing ETI in emergent situations.
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Affiliation(s)
- Seung Jae Choi
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae Kon Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byeong Soo Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Republic of Korea
| | - Minwoo Cho
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Bioengineering, Seoul National University, Seoul, Republic of Korea
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Emara TA, El-Anwar MW, Omara TA, Anany A, Elawa IA, Rabea MM. Submental intubation versus tracheostomy in maxillofacial fractures. Oral Maxillofac Surg 2019; 23:337-341. [PMID: 31093795 DOI: 10.1007/s10006-019-00771-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare submental intubation with tracheostomy in patients with maxillofacial fractures who were operated under general anesthesia and nasotracheal intubation was contraindicated. PATIENTS AND METHODS This prospective comparative study was conducted on 32 patients undergoing maxillofacial operations. All patients had a panfacial trauma (including naso-ethmoid orbital fracture combined with mandibular fracture). Patients who had unstable cervical vertebra, laryngeal trauma, urgent tracheostomy, and patients with expected prolonged postoperative ventilation were excluded from the study. Patients were randomly assigned to elective tracheostomy and submental intubation groups. The patients were evaluated according to the time required to do elective tracheostomy or submental intubation, the operation comorbidity and complications, and the postoperative scar. RESULTS The average time required to do submental intubation was 8.35 min versus 30.75 min required to do elective tracheostomy with significant difference (p < 0.0001). No complication was reported with submental intubation while in elective tracheostomy group, surgical emphysema was registered in two patients. The submental scar was acceptable in all patients while the tracheostomy scar needs scar revision in four cases (p = 0.0325). CONCLUSION Submental endotracheal intubation appeared to be a simple, safe, and significantly faster reliable alternative to tracheostomy during surgical reconstruction of selected cases of maxillofacial fractures without indication for prolonged postoperative ventilation support with significantly lower morbidity.
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Affiliation(s)
- Tarek Abdelzaher Emara
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammad Waheed El-Anwar
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | | | - Ahmed Anany
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohamed Mohamed Rabea
- Otorhinolaryngology-Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Submental intubation: a retrospective review of 45 cases. Ir J Med Sci 2012; 182:309-13. [PMID: 23224988 DOI: 10.1007/s11845-012-0886-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Airway management in patients undergoing maxillofacial surgery requires special consideration. A number of options including oro- or naso-tracheal intubation and tracheostomy are available. Submental intubation is now a recognised method of airway control during maxillofacial surgery. It provides a secure airway and does not interfere with maxillomandibular fixation or access to naso-orbito-ethmoid fractures. It avoids potential complications associated with nasotracheal intubation and tracheostomy in patients with multiple facial fractures, and obviates the need to alternate between oral and nasal intubation intra-operatively. METHODS This is a ten year retrospective review of patients who underwent submental intubation in a Regional Oral and Maxillofacial Surgery Department. The following variables were recorded: patient gender and age, preoperative diagnosis, duration of intubation, and complications associated with the intubation technique. RESULTS Submental intubation was performed 45 times on 45 patients. There were no complications relating to the submental intubation procedure. CONCLUSION Submental intubation should be considered as an option for airway management in selected cases of craniomaxillofacial surgery. It is a quick and safe technique with minimal morbidity and a low complication rate. It allows access to the maxillofacial skeleton intra-operatively and does not preclude the use of intermaxillary fixation.
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Rudraraju P, Eisen LA. Analytic Review: Confirmation of Endotracheal Tube Position: A Narrative Review. J Intensive Care Med 2009; 24:283-92. [PMID: 19654121 DOI: 10.1177/0885066609340501] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endotracheal tube (ETT) insertion is the primary method of definitive airway protection and control in critically ill patients. Detection of ETT malposition in a timely fashion is crucial in both elective and emergent intubation. In this review, we describe classic tests and highlight several new technologies that may assist the practitioner in determining ETT position within the esophago-tracheal complex, namely ultrasonographic and impedance-based methods. Strengths and weaknesses of particular methods are highlighted. Although many physical examination maneuvers have been described, reliance on the physical examination alone is insufficient for confirmation. Touted methods that appear failsafe, such as direct visualization of the ETT traversing the vocal cords have limitations, especially when dealing in the emergency setting accompanying a difficult to visualize airway. While carbon dioxide detection is an excellent confirmatory method, it is not infallible. Esophageal detection devices are useful as an alternative means of confirmation. New methods such as ultrasonic location of the ETT show promise but require further study. The clinician performing ETT insertion should have multiple confirmation methods that allow the practitioner to adapt to a variety of clinical situations, depending on local costs and availability. Finally, when the clinician still has uncertainty, or multiple tests give conflicting results, the availability of bronchoscopy at the bedside to visualize the carina through the ETT is useful.
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Affiliation(s)
- Praveen Rudraraju
- Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Lewis Ari Eisen
- Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Meyer C, Valfrey J, Kjartansdottir T, Wilk A, Barrière P. Indication for and technical refinements of submental intubation in oral and maxillofacial surgery. J Craniomaxillofac Surg 2003; 31:383-8. [PMID: 14637068 DOI: 10.1016/j.jcms.2003.07.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In maxillofacial injuries, a choice has often to be made between different ways of intubation when surgical access to both the nasal and the oral cavities is necessary. Submental intubation is an interesting alternative to tracheotomy, especially when short-term postoperative control of the airway is foreseeable, and as control of the dental occlusion is complete, and access to the nose and mouth is undisturbed. MATERIAL This kind of intubation has been used in our department in 25 cases since 1997. All patients had fractures disturbing the dental occlusion plus either an associated fracture of the skull base, or a displaced nasal fracture. RESULTS There was no intra-operative complication, average intubation duration was 1.5 days. Post-operative complications consisted of one case with hypertrophic scarring and two cases of abscess formation in the floor of the mouth. All these completely healed following local conservative treatment. CONCLUSION Submental intubation demands certain technical skills but it is simple, rapid and may avoid tracheotomy in selected patients.
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Affiliation(s)
- Christophe Meyer
- Department of Maxillofacial Surgery, University Hospital of Strasbourg, France.
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Abstract
In conclusion, though there has been a dramatic reduction in the acute complications of artificial airways in the last hundred years, it remains crucial for the intensivist/anesthesiologist to have an implicit understanding of the anatomy and physiology of the process of ETI. As new techniques such as PDT are introduced, we must investigate their utility compared with the current standard of care in the most rigorous fashion. Additionally, as many of the complications of ETI can lead to increases in morbidity and mortality, prompt diagnosis and management are essential.
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Affiliation(s)
- David Feller-Kopman
- Medical Procedure Service, Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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