ENDOTRACHEAL-TUBE SELECTION IN CHILDREN - A COMPARISON OF 4 METHODS
ENDOTRACHEAL-TUBE SELECTION IN CHILDREN - A COMPARISON OF 4 METHODS
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DOI：
10.1016/s0196-0644(05)81937-7
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发表时间：
1993-03-01
影响因子：
6.2
通讯作者：
SCHREINER, MS
中科院分区：
文献类型：
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作者：
KING, BR;BAKER, MD;SCHREINER, MS
研究目的：确定四种气管插管尺寸选择方法在儿科人群中的准确性。研究设计：前瞻性、盲法比较。设置：费城儿童医院。参与者：237名1个月至9岁的儿童，接受需要气管插管的择期手术。选择程序：对比样本。干预措施：本文比较了四种确定小儿气管插管合适尺寸的方法。这些方法包括与第五指宽度的直接比较，使用戒指测量装置与第五指直径的直接比较，与第五指指甲宽度的直接比较，以及使用公式（[年龄+l 6]/4）进行估计。在婴儿中，3个月及以下的婴儿预计使用3.0 mm（内径）气管插管，3 - 9个月的婴儿预计使用3.5 mm气管插管。记录手术室中使用的气管内导管的尺寸，以及导管周围的“漏气”。一个适当大小的气管内管确定的空气泄漏与通气压力之间的5和40 cm的水。主要结果：直接比较使用的宽度和直径的第五个手指预测的气管内管1毫米之间的小和0.5毫米大于麻醉师使用的11%和14%的患者，分别。基于年龄的公式预测97.5%的患者气管插管尺寸在此范围内，与第五指甲宽度直接比较预测91%的患者气管插管尺寸在此范围内。这些结果是一致的，在所有年龄组studied.Conclusion：无论是第五指宽度，也没有第五指直径准确预测适当的气管内导管的大小在大多数儿童。使用基于年龄的公式可以做出更准确的估计，但是当孩子的年龄未知或计算困难或不可能时，可以使用第五个指甲的宽度做出准确的估计。
Study objective: To determine the accuracy of four methods of endotracheal tube size selection in the pediatric population.Study design: Prospective, blinded comparison.Setting: The Children's Hospital of Philadelphia.Participants: Two hundred thirty-seven children aged 1 month to 9 years old undergoing elective surgery requiring endotracheal intubation.Selection procedures: Consecutive sample.Interventions: Four methods of determining proper endotracheal tube size in children were compared. These methods included direct comparison with the width of the fifth finger, direct comparison with the diameter of the fifth finger using a ring-sizing device, direct comparison with the width of the fifth fingernail, and estimation using a formula ([age in years + l6]/4). In infants, a 3.0-mm (internal diameter) endotracheal tube was predicted for those 3 months of age and younger, and a 3.5-mm endotracheal tube was predicted for those from 3 to 9 months of age. The size of the endotracheal tube used in the operating room was recorded, as was the ''air leak'' around the tube. An appropriately sized endotracheal tube was determined by an air leak with ventilation pressures between 5 and 40 cm of water.Main results: Direct comparison using the width and the diameter of the fifth finger predicted an endotracheal tube between 1 mm smaller and 0.5 mm larger than that used by the anesthesiologists in 11% and 14% of patients, respectively. The age-based formula predicted an endotracheal tube size in this range in 97.5% of patients, and direct comparison with the width of the fifth fingernail predicted an endotracheal tube in this same range in 91% of patients. These findings were consistent within all age groups studied.Conclusion: Neither fifth finger width nor fifth finger diameter accurately predicts proper endotracheal tube size in most children. A more accurate estimation can be made using the age-based formula, but when the child's age is unknown or when calculation is awkward or impossible, an accurate estimate can be made using the width of the fifth fingernail.