Weiss M, Gerber A C, Dullenkopf A
Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
Br J Anaesth. 2005 Jan;94(1):80-7. doi: 10.1093/bja/aeh294. Epub 2004 Oct 14.
The aim of this study was to evaluate the appropriateness of intubation depth marks on the new Microcuff paediatric tracheal tube.
With local Institutional Ethics Committee approval and informed parental consent, we included patients from birth (weighing > or =3 kg) to 16 yr who were undergoing general anaesthesia requiring orotracheal intubation. Tracheal intubation was performed using direct laryngoscopy, the intubation depth mark was placed between the vocal cords, and the tube was taped to the lateral corner of the mouth. The distance between the tube tip and the tracheal carina was assessed by flexible bronchoscopy with the patients in supine, and their head in neutral positions. Tube sizes were selected according to the formula: internal diameter (ID; mm)=(age/4)+3.5 in children > or =2 yr. In full-term newborns (> or =3 kg) to less than 1 yr ID 3.0 mm tubes were used and in children from 1 to less than 2 yr ID 3.5 mm tubes were used. Endoscopic examination was performed in 50 size ID 3.0 mm tubes, and in 25 tubes of each tube size from ID 3.5 to 7.0 mm. Tracheal length and percentage of the trachea to which the tube tip was advanced were calculated.
250 patients were studied (105 girls, 145 boys). The distance from the tube tip to the carina ranged from 1.4 cm in a 2-month-old infant (ID 3.0 mm) to 7.7 cm in a 14-yr-old boy (ID 7.0 mm). Mean tube insertion into the trachea was 53.2% (6.3) of tracheal length with a minimum of 40% and a maximum of 67.6%.
The insertion depth marks of the new Microcuff paediatric tracheal tube allow adequate placing of the tracheal tube with a cuff-free subglottic zone and without the risk for endobronchial intubation in children from birth to adolescence.
本研究旨在评估新型带微型套囊小儿气管导管上插管深度标记的适宜性。
经当地机构伦理委员会批准并获得家长知情同意后，纳入出生（体重≥3 kg）至16岁接受需要经口气管插管的全身麻醉的患者。采用直接喉镜进行气管插管，将插管深度标记置于声带之间，并将导管固定于口角外侧。患者仰卧位、头部处于中立位时，通过可弯曲支气管镜评估导管尖端与气管隆突之间的距离。根据公式选择导管尺寸：2岁及以上儿童的内径（ID；mm）=（年龄/4）+3.5。足月新生儿（≥3 kg）至1岁以下使用内径3.0 mm的导管，1至2岁以下儿童使用内径3.5 mm的导管。对50根内径3.0 mm的导管以及内径3.5至7.0 mm的每种导管尺寸中的25根导管进行了内镜检查。计算气管长度以及导管尖端进入气管的比例。
共研究了250例患者（105例女孩，145例男孩）。导管尖端至隆突的距离范围为2个月大婴儿（内径3.0 mm）的1.4 cm至14岁男孩（内径7.0 mm）的7.7 cm。导管平均插入气管的深度为气管长度的53.2%（6.3%），最小值为40%，最大值为67.6%。
新型带微型套囊小儿气管导管的插入深度标记可使气管导管放置适当，声门下区域无套囊，且从出生至青春期的儿童不会发生支气管内插管风险。
