DOI: https://doi.org/10.14710/jai.v0i0.73108

Comparison of the Success of Emergency Intubation with the Heaven Score and The Lemon Score in Critically Ill Patients Who Require Mechanical Ventilation

Department of Anesthesiology and Intensive Therapy, Universitas Sumatera Utara, Jl. dr. T. Mansur No. 66 USU Medan, Indonesia

Received: 9 May 2025; Revised: 16 Dec 2025; Accepted: 24 Dec 2025; Available online: 24 Dec 2025.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

Citation Format:
Cover Image
Abstract

Background : The LEMON and HEAVEN scores are currently only being used to assess airway difficulties in emergency patients. This research was conducted to evaluate the success of emergency intubation using the LEMON and HEAVEN scores in critically ill patients who require mechanical ventilation.

Objective : The objective of this study is to compare the success of emergency intubation with the HEAVEN score with the LEMON score in critically ill patients requiring mechanical ventilation.

Methods : This research employed a cross-sectional observational analytical design and took place at Haji Adam Malik General Hospital Medan, Dr. Pirngadi Medan, and RSU Haji Medan from January to March 2024. All critically ill patients aged 18-64 years requiring emergency intubation were included, excluding those with prior tracheotomy or intubation experience and refused to participate. A minimum sample size of 70 participants was obtained, with statistical analysis planned using SPSS version 26 software.

Result : In this study, a total of 76 patients were included. According to the LEMON score, 5 patients (6.6%) were identified as having difficult intubation, whereas the HEAVEN score categorized 30 patients (39.5%) as difficult cases. Following emergency intubation, only 3 patients (3.9%) experienced initial intubation failure. The LEMON score demonstrated an area under the curve (AUC) of 0.984, indicating excellent accuracy, while the HEAVEN score had an AUC of 0.911, also demonstrating excellent accuracy. Both scores proved equally effective in assessing intubation success, with statistical analysis favoring the superiority of the LEMON score. However, the HEAVEN score can serve as a viable alternative in critically ill patients.

Conclusion : The LEMON score and HEAVEN score can be used to evaluate the success of emergency department intubation in critically ill patients who require mechanical ventilation.

Note: This article has supplementary file(s).

Fulltext |  common.other
Ethics Committee
Subject
Type Other
  Download (231KB)    Indexing metadata
 common.other
Copyright Transfer Agreement
Subject
Type Other
  Download (21KB)    Indexing metadata
Keywords: Emergency intubation, LEMON score, HEAVEN score, critically ill patients, mechanical ventilation

Article Metrics:

Article Info
Section: Original Articles
Language : EN
Recent articles
Comparison of the Success of Emergency Intubation with the Heaven Score and The Lemon Score in Critically Ill Patients Who Require Mechanical Ventilation Comparison of The Efficacy of Intravenous Norepinephrine and Phenylephrine as Vasopressor Agents in The Management of Septic Shock in ICU Patients at Haji Adam Malik General Hospital Using Lactate and Stroke Volume Variation Indicators Implementation of clinical ethics in Anesthesiology services to improve the quality of patient care Anesthesia for ASD Closure in Robotic-Assisted Cardiac Surgery: A Case Report Interlaminar Cervical Epidural Non-Particulate Steroid Injection for Acute Cervical Radicular Pain: A Case Study of Clinical Effectiveness ERECTOR SPINAE PLANE BLOCK IN THORACOTOMY SURGERY Prognostic Value of the Lactate/Albumin Ratio for Mortality in Sepsis-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis More recent articles
Most cited articles
Patofisiologi Penyakit Jantung Koroner Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida More cited articles
  1. Admass BA, Endalew NS, Tawye HY, et al. Evidence-based airway management protocol for a critically ill patient in medical intensive care unit: Systematic review. Ann Med Surg 2022; 80: 1042-84
  2. Cabrini L, Landoni G, Baiardo Redaelli M, et al. Correction to: Tracheal intubation in critically ill patients: A comprehensive systematic review of randomized trials. Crit Care 2019; 23: 1–9
  3. Natt B, Mosier J. Airway Management in the Critically Ill Patient. Curr Anesthesiol Rep 2021; 11: 116–127
  4. Cumberworth A, Lewith H, Sud A, et al. Major complications of airway management: a prospective multicentre observational study. Anaesthesia 2022; 77: 640–648
  5. Srivilaithon W, Muengtaweepongsa S, Sittichanbuncha Y, et al. Predicting difficult intubation in emergency department by intubation assessment score. J Clin Med Res 2018; 10: 247–253
  6. Crewdson K, Fragoso-Iniguez M, Lockey DJ. Requirement for urgent tracheal intubation after traumatic injury: a retrospective analysis of 11,010 patients in the Trauma Audit Research Network database. Anaesthesia 2019; 74: 1158–1164
  7. Davis DP, Olvera DJ. HEAVEN criteria: derivation of a new difficult airway prediction tool. Air Med J 2017; 36: 195–197
  8. Tan NE, Yoong KPY, Yahya HMF. Use of HEAVEN criteria for predicting difficult intubation in the emergency department. Clin Exp Emerg Med 2022; 9: 29–35
  9. Şengel N, Karabulut G, Toprak ME, et al. Predictive values of LEMON and LEON scores in elective oral and maxillofacial surgery- correlation with intubation difficulty scale. Yüksek İhtisas Üniversitesi Sağlık Bilim Derg 2022; 3: 33–38
  10. Derakhshan P, Nikoubakht N, Alimian M, et al. Relationship between airway examination with LEMON criteria and difficulty of tracheal intubation with IDS criteria. Anesthesiol Pain Med; 13
  11. Jung W, Kim J. Factors associated with first-pass success of emergency endotracheal intubation. Am J Emerg Med 2020; 38: 109–113
  12. Kuzmack E, Inglis T, Olvera D, et al. A novel difficult-airway prediction tool for emergency airway management: validation of the HEAVEN criteria in a large air medical cohort. J Emerg Med 2018; 54: 395–401
  13. Nakazawa H, Uzawa K, Tokumine J, Lefor AK, Motoyasu A, Yorozu T. Airway ultrasound for patients anticipated to have a difficult airway: Perspective for personalized medicine. World Journal of Clinical Cases. 2023 Mar 26; 11(9): 1951–1962

Last update:

No citation recorded.

Last update: 2026-01-09 21:07:58

No citation recorded.