The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients
The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients
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DOI：
10.1111/pan.13220
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发表时间：
2017-10-01
影响因子：
1.7
通讯作者：
Camci, Emre
中科院分区：
文献类型：
--
作者：
Altun, Demet;Orhan-Sungur, Mukadder;Camci, Emre
背景资料：本前瞻性研究的目的是探讨成功的超声在儿科患者在确定适当大小的套囊气管插管，并比较结果与传统的高度为基础的（Broselow）磁带和基于年龄的公式管size.Methods：一百五十二名儿童的1-10岁，接受全身麻醉的腺样体切除术参加了这项研究。在所有参与者中，在呼吸暂停期间用超声测量声门下横径。选择外径与测量的声门下气道直径相匹配的气管插管。计算了基于年龄（Motoyama-Khine）和基于身高（Broselow）的气管插管尺寸。如果插管进入气管时遇到阻力，或者需要气道压力>25 cmH（2）O才能检测到可闻泄漏，则更换内径小于0.5 mm的气管插管。如果在气道压力25 cmH（2）O时出现漏气声或需要袖带压力>25 cmH（2）O来密封，则将插管改为大0.5 mm的内径。最佳配合管内径是满足前述条件的所得管内径。结果：88%的患儿经超声确定的气管插管内径与最佳匹配气管插管内径一致。15例患者更换为大一号气管插管，3例患者更换为大一号气管插管。使用Bland-Altman分析，一个更好的协议，观察超声测量，而不是基于高度的估计和基于年龄的formulation.Conclusion：我们的研究结果表明，声门下直径测量超声似乎是一个可靠的预测评估声门下直径的气道估计适当大小的小儿气管插管。
Background: The aim of this prospective study was to investigate the success of ultrasound in pediatric patients in determining the appropriate sized cuffed endotracheal tube and to compare the results with conventional height-based (Broselow) tape and age-based formula tube size.Methods: One hundred and fifty-two children of 1-10 years of age, who received general anesthesia for adenotonsillectomy were enrolled to the study. In all participants, the transverse diameter of the subglottis was measured with ultrasound during apnea. An endotracheal tube was chosen with the outer diameter matched to the measured subglottic airway diameter. An age-based (Motoyama-Khine) and height-based (Broselow) endotracheal tube size was calculated. If there was resistance to passage of the tube into the trachea or an airway pressure >25 cmH(2)O was required to detect an audible leak, the endotracheal tube was replaced with internal diameter of 0.5 mm smaller. If there was an audible leak at airway pressure 25 cmH(2)O or a cuff pressure >25 cmH(2)O was required to seal, the tube was changed to the 0.5 mm larger internal diameter. Best-fit tube internal diameter was the resultant tube internal diameter that met the previously stated conditions. The need for endotracheal tube replacement and peak airway pressure were recorded.Results: The internal diameter of ultrasound determined tube was the same as best-fit tube in 88% of children. Endotracheal tube was replaced in 15 patients with a one size larger, and in three patients with one size smaller tube. Using Bland-Altman analysis, a better agreement was observed with ultrasound measurement rather than height-based estimation and age-based formulas.Conclusion: Our findings show that subglottic diameter measured by ultrasound appears to be a reliable predictor for the assessment of the subglottic diameter of the airway in estimating appropriate size pediatric endotracheal tube.