MACOCHA Score for Difficult Intubation in ICU
Predicts difficult intubation in critically ill patients in the ICU. MACOCHA = Mallampati III or IV, Apnoea/OSA, reduced mobility of Cervical spine, Opening mouth, Coma, Hypoxaemia, non-Anaesthesiologist.
Score interpretation
MACOCHA 0–2: difficult intubation unlikely (negative predictive value 98 % at the cut-off of 3; De Jong 2013).
→ Standard intubation technique; direct laryngoscopy or video laryngoscopy; standard preparation
MACOCHA ≥ 3: increased risk of difficult intubation (validation cohort: sensitivity 73 %, specificity 89 %, positive predictive value 36 %).
→ Call experienced intubator (anaesthesiologist); video laryngoscopy as first choice; difficult airway trolley at bedside; standby cricothyrotomy kit; preoxygenate with HFNC
Interpretation bands for the MACOCHA Score. Apply clinical judgement and local guidance.
References
- De Jong A et al. MACOCHA score: derivation and validation of a new score predictive of difficult intubation in ICU. Am J Respir Crit Care Med. 2013;187(8):832–839.
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Curated clinical cross-links plus same-class fallbacks.
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Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.