{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:07:26Z","timestamp":1793383646445,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2013,4,1]],"date-time":"2013-04-01T00:00:00Z","timestamp":1364774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Difficult intubation in the intensive care unit (ICU) is a challenging issue.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To develop and validate a simplified score for identifying patients with difficult intubation in the ICU and to report related complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data collected in a prospective multicenter study from 1,000 consecutive intubations from 42 ICUs were used to develop a simplified score of difficult intubation, which was then validated externally in 400 consecutive intubation procedures from 18 other ICUs and internally by bootstrap on 1,000 iterations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>In multivariate analysis, the main predictors of difficult intubation (incidence = 11.3%) were related to patient (Mallampati score III or IV, obstructive sleep apnea syndrome, reduced mobility of cervical spine, limited mouth opening); pathology (severe hypoxia, coma); and operator (nonanesthesiologist). From the \u03b2 parameter, a seven-item simplified score (MACOCHA score) was built, with an area under the curve (AUC) of 0.89 (95% confidence interval [CI], 0.85\u20130.94). In the validation cohort (prevalence of difficult intubation = 8%), the AUC was 0.86 (95% CI, 0.76\u20130.96), with a sensitivity of 73%, a specificity of 89%, a negative predictive value of 98%, and a positive predictive value of 36%. After internal validation by bootstrap, the AUC was 0.89 (95% CI, 0.86\u20130.93). Severe life-threatening events (severe hypoxia, collapse, cardiac arrest, or death) occurred in 38% of the 1,000 cases. Patients with difficult intubation (n = 113) had significantly higher severe life-threatening complications than those who had a nondifficult intubation (51% vs. 36%; P &amp;lt; 0.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Difficult intubation in the ICU is strongly associated with severe life-threatening complications. A simple score including seven clinical items discriminates difficult and nondifficult intubation in the ICU.<\/jats:p>\n                    <jats:p>Clinical trial registered with www.clinicaltrials.gov (NCT01532063).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201210-1851oc","type":"journal-article","created":{"date-parts":[[2013,1,25]],"date-time":"2013-01-25T00:32:47Z","timestamp":1359073967000},"page":"832-839","source":"Crossref","is-referenced-by-count":322,"title":["Early Identification of Patients at Risk for Difficult Intubation in the Intensive Care Unit"],"prefix":"10.1093","volume":"187","author":[{"given":"Audrey","family":"De Jong","sequence":"first","affiliation":[{"name":"Intensive Care and Anesthesiology Department, University of Montpellier Saint Eloi Hospital, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Molinari","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Montpellier Lapeyronie Hospital, UMR 729 MISTEA, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Terzi","sequence":"additional","affiliation":[{"name":"INSERM, U1075, University of Caen, CHRU Caen, Service de R\u00e9animation M\u00e9dicale, Caen, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Mongardon","sequence":"additional","affiliation":[{"name":"Medical Intensive Care, Cochin Hospital, Assistance Publique des H\u00f4pitaux de Paris Universit\u00e9 Paris Descartes, Sorbonne Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Arnal","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Sainte Musse Hospital, Toulon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Guitton","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, H\u00f4tel-Dieu Teaching Hospital, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Allaouchiche","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Edouard-Herriot Teaching Hospital, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Paugam-Burtz","sequence":"additional","affiliation":[{"name":"Intensive Care and Anesthesiology Department, University of Paris Diderot, Sorbonne Paris Cit\u00e9, Paris, France"},{"name":"AP-HP, H\u00f4pital Beaujon, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Constantin","sequence":"additional","affiliation":[{"name":"Intensive Care and Anesthesiology Department, Hotel-Dieu Hospital, University Hospital of Clermont Ferrand, Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Yves","family":"Lefrant","sequence":"additional","affiliation":[{"name":"Intensive Care and Anesthesiology Department, University of Montpellier, Nimes Hospital, Nimes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Leone","sequence":"additional","affiliation":[{"name":"Intensive Care and Anesthesiology Department and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Papazian","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, University Hospital, Nord Hospital, Marseille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Asehnoune","sequence":"additional","affiliation":[{"name":"Intensive Care and Anesthesiology Department, University of Nantes, Hotel-Dieu Hospital, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Maziers","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie","family":"Azoulay","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, University of Paris-Diderot, Saint Louis Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gael","family":"Pradel","sequence":"additional","affiliation":[{"name":"Intensive Care Department, Centre Hospitalier d\u2019Avignon, Avignon, France; 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