The development of prediction model for cuffed tracheal tube size from the middle finger in pediatrics: a concise and feasible approach.
The development of prediction model for cuffed tracheal tube size from the middle finger in pediatrics: a concise and feasible approach.
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DOI：
10.21037/tp-23-502
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发表时间：
2023-12-26
影响因子：
2
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中科院分区：
文献类型：
--
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选择最佳气管插管尺寸对儿科患者至关重要。通常使用基于时间的公式，但仍有局限性。这项前瞻性研究的目的是调查中指测量值是否与带套囊气管插管尺寸相关，并进一步开发基于这些测量值的预测模型。本研究入组了计划进行涉及气管插管的择期手术的12岁以下患者。长度是从远端掌骨的尖端到手掌侧的手掌根部确定的，而周长是使用软卷尺在手掌基部测量的。根据特定标准确定适当的套囊气管插管尺寸。如果插管在插入过程中遇到阻力或需要气道压力>25 cmH2O才能检测到可闻泄漏，则将其更换为小0.5 mm的插管。相反，如果在气道压力<10 cm H2O或峰值压力>25 cm H2O或袖带压力>25 cm H2O时发生可听到的泄漏，则更换为直径大于0.5 mm的导管。使用线性回归分析来检查中指周长和长度与带套囊气管导管尺寸之间的关系。随后，根据线性回归分析的结果构建回归方程，并将其预测性能与传统的基于年龄的公式（包括Khine公式和Motoyama公式）进行比较。通过平均绝对误差（MAE）、均方根误差（RMSE）和预测精度评价预测性能。我们的研究共分析了261例患者。患者平均年龄为46.19±35.83个月。带套囊气管导管尺寸与中指周长和中指长度呈线性关系，R2值分别为0.77和0.73。与传统的基于年龄的公式相比，中指周长和中指长度都表现出上级的预测性能，其特征在于更低的MAE和RMSE，以及更高的预测精度。值得注意的是，基于中指周长的回归方程获得了更高的预测精度0.590，MAE为0.259，RMSE为0.333，而传统的基于年龄的公式的预测精度为0.391，MAE为0.349，RMSE为0.473。基于线性回归的回归系数，提出了简化的公式，其中中指周长公式是最准确和最简单的选择。根据中指周长可预测带套囊气管导管的合适尺寸。我们提出的公式“套囊气管插管内径（mm）=中指周长（cm）− 0.2”有可能改善儿科患者套囊气管插管尺寸的选择。
Selecting the optimal tracheal tube size is critically important for pediatric patients. Age-based formulas are often used, but still have limitations. The aim of this prospective study was to investigate whether middle finger measurements correlate with cuffed tracheal tube size and to further develop a prediction model based on these measurements. Patients under 12 years of age scheduled for elective surgery involving tracheal intubation were enrolled in the study. The length was determined from the tip of the distal metacarpal to the palm’s root on the palm side, while the circumference was measured at the base of the palm using a soft tape measure. The appropriate cuffed tracheal tube size was determined based on specific criteria. If the tube encountered resistance during insertion or required an airway pressure >25 cmH2O to detect an audible leak, it was replaced with a tube 0.5 mm smaller. Conversely, if an audible leak occurred at an airway pressure <10 cmH2O, or peak pressure >25 cmH2O, or the cuff pressure >25 cmH2O to achieve a seal, the tube was exchanged for one with a 0.5 mm larger. Linear regression analysis was used to examine the association between middle finger circumference and length with the cuffed tracheal tube size. Subsequently, regression equations were constructed based on the results of the linear regression analysis and their predictive performance was compared to the conventional age-based formulas, including the Khine formula and Motoyama formula. The predictive performance was evaluated by mean absolute error (MAE), root mean square error (RMSE), and prediction accuracy. A total of 261 patients were analyzed in our study. The mean age of the patients was 46.19±35.83 months. The linear relationship was observed between the cuffed tracheal tube size and the middle finger circumference and middle finger length with R2 values of 0.77 and 0.73, respectively. In comparison to conventional age-based formulas, both middle finger circumference and middle finger length demonstrated superior predictive performance, characterized by lower MAE and RMSE, as well as higher prediction accuracy. Notably, the regression equation based on the middle finger circumference obtained the higher predictive accuracy of 0.590, with an MAE of 0.259 and an RMSE of 0.333 as opposed to the predictive accuracy of 0.391, MAE of 0.349, and RMSE of 0.473 derived from conventional age-based formulas. Based on the regression coefficients of linear regression, simplified formulas were proposed, with the middle finger circumference-based formula emerging as the most accurate and simple option. The appropriate cuffed tracheal tube size could be predicted by the middle finger circumference. Our proposed formula ‘cuffed tracheal tube internal diameter (mm) = middle finger circumference (cm) − 0.2’ has the potential to improve the selection of the cuffed tracheal tube size in pediatric patients.
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影响因子：
2.6
作者：
Zhou, Miao;Xu, Wen Y.;Xu, Sheng;Zang, Qing L.;Li, Qi;Tan, Li;Hu, Yong C.;Ma, Ning;Xia, Jian H.;Liu, Kun;Ye, Min;Pu, Fei Y.;Chen, Liang;Song, Li J.;Liu, Yang;Jiang, Lai;Gu, Lin;Zou, Zui
通讯作者：
Zou, Zui
影响因子：
1.7
作者：
Altun, Demet;Orhan-Sungur, Mukadder;Camci, Emre
通讯作者：
Camci, Emre
影响因子：
6.2
作者：
KING, BR;BAKER, MD;SCHREINER, MS
通讯作者：
SCHREINER, MS
DOI：
10.1007/bf03009476
发表时间：
1993-11-01
期刊：
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
影响因子：
--
作者：
SCHWARTZ, RE;STAYER, SA;PASQUARIELLO, CA
通讯作者：
PASQUARIELLO, CA
使用印刷的三维气道模型在先天性心脏病患者中预测气管管的大小：一项前瞻性，单中心，单组研究。
影响因子：
2.9
作者：
Park S;Ahn J;Yoon SU;Choo KS;Kim HJ;Chung M;Kim HY
通讯作者：
Kim HY