Prediction of Pediatric Endotracheal Tube Size by Ultrasonography
Prediction of Pediatric Endotracheal Tube Size by Ultrasonography
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DOI：
10.1097/aln.0b013e3181ef6757
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发表时间：
2010-10-01
期刊：
影响因子：
8.8
通讯作者：
Sessler, Daniel I.
中科院分区：
文献类型：
--
作者：
Shibasaki, Masayuki;Nakajima, Yasufumi;Sessler, Daniel I.
背景：基于年龄和身高的公式往往不能可靠地预测儿科患者合适的气管导管(ETT)大小。因此，我们验证了声门下直径比现有方法更好地预测最佳ETT大小的假设。方法：共有192名年龄在1个月至6岁之间、计划接受手术并接受全身麻醉的患者入选，分为发育和验证两个阶段。在发育组，根据标准的带袖口和不带袖口管的年龄公式选择最佳的ETT尺寸。根据需要更换管子，直到获得良好的临床适合性。B超测定气管插管前声门下上气道内径。我们建立了声门下上气道直径与最终选定的ETT外径之间的回归方程。在验证组中，使用此回归方程在超声检查后选择ETT大小。结果：声门下上气道直径与ETT外径高度相关，在临床上被认为是最佳的。超声测量预测的ETT大小与临床选择的ETT大小的符合率：有袖带的ETT为98%，无袖带的ETT为96%。结论：超声测量声门下气道直径有助于选择合适大小的儿科ETT。这种选择方法比基于年龄和身高的标准公式更能预测最优的ETT外径。
Background: Formulas based on age and height often fail to reliably predict the proper endotracheal tube ( ETT) size in pediatric patients. We, thus, tested the hypothesis that subglottic diameter, as determined by ultrasonography, better predicts optimal ETT size than existing methods.Methods: A total of 192 patients, aged 1 month to 6 yr, who were scheduled for surgery and undergoing general anesthesia were enrolled and divided into development and validation phases. In the development group, the optimal ETT size was selected according to standard age-based formulas for cuffed and uncuffed tubes. Tubes were replaced as necessary until a good clinical fit was obtained. Via ultrasonography, the subglottic upper airway diameter was determined before tracheal intubation. We constructed a regression equation between the subglottic upper airway diameter and the outer diameter of the ETT finally selected. In the validation group, ETT size was selected after ultrasonography using this regression equation. The primary outcome was the fraction of initial cuffed and uncuffed tube sizes, as selected through the regression formula, that proved clinically optimal.Results: Subglottic upper airway diameter was highly correlated with outer ETT diameter deemed optimal on clinical grounds. The rate of agreement between the predicted ETT size based on ultrasonic measurement and the final ETT size selected clinically was 98% for cuffed ETTs and 96% for uncuffed ETTs.Conclusions: Measuring subglottic airway diameter with ultrasonography facilitates the selection of appropriately sized ETTs in pediatric patients. This selection method better predicted optimal outer ETT diameter than standard age- and height-based formulas.