Date of Award

Spring 4-18-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Dr. Kacy Ballard, DNP, CRNA

First Committee Member

Dr. Chai Sribanditmongkol PhD, RN, IBCLC, CNS

Second Committee Member

Dr. Amy Bishop, DNP, AGCNS


Airway, Difficult, Intubation, Ultrasound, Laryngoscopy, Adult

Subject Categories

Anesthesiology | Critical Care Nursing | Medical Specialties | Medicine and Health Sciences | Nursing


Adverse respiratory events are the most common injuries in anesthesia; difficult intubation and ventilation contribute to most cases. Injuries following inadequate airway management include cerebral hypoxia, aspiration, and cardiac arrest. Despite the risk and consequences following inadequate airway management, most medical facilities lack standardized airway assessments for anesthesia providers. Current evidence implicates that ultrasound measurement of the hyomental distance demonstrates the highest specificity and accuracy in predicting difficult intubation. The traditional approach to conducting airway assessments includes Mallampati classification, which shows high specificity for predicting difficult airways only when combined with other airway assessments. The purpose of this evidence-based project is to recommend clinical guidelines for standardized airway assessments with the combined use of ultrasound and Mallampati classifications. The Johns Hopkins Nursing Evidence-based Model will guide the project team through project planning, development, completion, and dissemination. A literature review, analysis, and critical appraisal of available evidence will be conducted to support recommendations regarding clinical practice protocols for airway assessments utilizing ultrasonography and Mallampati classifications. Project facilitators will engage with anesthesia providers using pre and post-implementation surveys and provide formal ultrasound training. Ultrasound evaluation for airway management is a new addition to preoperative airway assessments that will allow anesthesia providers to revolutionize patient care and reduce perioperative morbidity and mortality. Guidelines for standardized airway assessments have been established and will be recommended to the hospital of interest for review, discussion, and determination regarding the potential for implementation.

Acknowledgement 1


Acknowledgement 2


Licensing Permission

Copyright, all rights reserved. Fair Use



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