Predictability of Heaven Criteria for Difficult Airway in a Tertiary Care ICU

INTRODUCTION: Effective airway management is a cornerstone of intensive care, with critical implications for patient outcomes. This study explores the utility of the HEAVEN criteria as a predictive tool for difficult airway management in the ICU, focusing on both anatomical and physiological parameters. By assessing the diagnostic accuracy of this scoring system, the research aims to bridge the gap between theoretical frameworks and practical applications in a tertiary care setting. The study's findings contribute to optimizing airway management strategies, thereby enhancing patient safety and clinical efficacy in critical care scenarios. OBJECTIVES: This study aimed to evaluate the utility of the HEAVEN criteria in predicting anatomically and physiologically difficult airways among ICU patients. Specifically, it sought to assess the diagnostic accuracy of individual and cumulative HEAVEN criteria, their association with airway complications, and their correlation with Cormack-Lehane grading. MATERIALS AND METHODS: This prospective observational study was conducted at the Pushpagiri Institute of Medical Sciences and Research Centre, involving 118 ICU patients requiring emergency intubation. The HEAVEN criteria were assessed for each patient before intubation. Difficult airways were classified into two types: anatomically difficult (requiring more than one intubation attempt) and physiologically difficult (associated with hypoxemia, hypotension, or cardiac arrest). Data analysis included chi-square tests, logistic regression, and ROC curve evaluations to determine sensitivity, specificity, and predictive accuracy. RESULTS: Anatomical challenges and vomitus/secretions were significantly associated with anatomically difficult airways (p = 0.007 and p = 0.005, respectively), while no HEAVEN criteria showed statistical significance for physiologically difficult airways. Hypoxemia was the most sensitive predictor for both anatomically (85.29%) and physiologically difficult airways (78.33%), although it had low specificity. The diagnostic accuracy improved with an increasing number of HEAVEN criteria, reaching 100% specificity when five criteria were present. Logistic regression revealed a significant positive association between higher HEAVEN scores and anatomically difficult airways (odds ratio = 2.237 per criterion). CONCLUSION: The HEAVEN criteria demonstrate moderate utility in predicting anatomically difficult airways but limited value for identifying physiologically difficult ones. While the criteria can aid in pre-intubation planning, they should be used in conjunction with clinical judgment. Further multicenter studies are needed to validate these findings and improve the generalizability of the HEAVEN criteria in ICU populations.