Truong and Truong described the VIA score for airway assessment and management. The authors are from the University of Texas MD Anderson Cancer Center.
VIA is an acronym for ventilation (V), intubation (I) and aspiration risk (A).
Parameter
Finding
Points
ventilation
bag/mask ventilation readily assured
0
supraglottic device may be needed to ensure adequate ventilation
1
impossible to ventilate after induction of general anesthesia
2
intubation
successful with conventional direct laryngoscopy
0
advanced intubating device or special skills needed
1
impossible to intubate after induction of general anesthesia
2
aspiration risk
minimal
0
risk can be overcome by rapid sequence induction with cricoid pressure (full stomach, etc)
1
high risk
2
where:
• A patient may be impossible to ventilate because of an anterior mediastinal mass compressing the trachea or a tracheoesophageal fistula.
• A patient may be impossible to intubate because of a large supraglottic tumor or an airway disrupted by trauma.
• A patient may be at high risk for aspiration because of high-grade intestinal obstruction, active vomiting, or an esophageal anastomotic leak.
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the greater the risk.
Score
Risk
Management
0
very low risk
routine induction
1
low risk
induction of general anesthesia with required precautions
2
moderate risk
awake intubation by specialist in difficult airway management
3
high risk
awake intubation; surgeon available to establish a patent airway if problems arise
4
very high risk
awake tracheostomy
5 or 6
exceptionally high risk
tracheostomy not effective; require femorofemoral cardiopulmonary bypass
where:
• Any single item scored 2 might raise the risk more than 2 items scored 1.
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