Daugherty Reza James, Nadkarni Vinay, Brenn Bruce Randall
Division of Pediatric Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pediatr Emerg Care. 2006 Nov;22(11):710-7. doi: 10.1097/01.pec.0000238743.96606.69.
To compare length-based estimates of endotracheal tube (ETT) size and age-based estimates with anesthesiologist-selected ideal ETT size in children with medical conditions affecting normal growth, known as pathological short stature (PSS).
We conducted a retrospective review of the anesthesia database of all children undergoing tracheal intubation for any surgical procedure during a 3-year period. The anesthesiologist-selected ideal ETT size was defined as that selected and successfully used throughout the case under the supervision of a board-certified pediatric anesthesiologist. Objective criteria, such as leak test and adequate oxygenation/ventilation, were used to validate the appropriateness of the ETT chosen. For analysis, the children were classified as normal length for age versus PSS, defined as less than 5% length for age on the Centers for Disease Control and Prevention growth chart. The proportions of clinically relevant predicted ETTs, within +/-0.5 mm of the anesthesiologist-selected ideal ETT size, based on both age- and length-based formulas for each group were then compared.
Five thousand one hundred seventy-five patient records were analyzed. In children with normal stature, age-predicted ETT size was within the clinically relevant range in 89.8% (95% confidence interval [CI], 88.9%-90.7%), and length-predicted ETT size was within the clinically relevant range in 92.8% (95% CI, 92.0%-93.6%). In children with PSS, age-predicted ETT size was within the clinically relevant range in 86.6% (95% CI, 84.3%-89.0%), and length-predicted ETT size was within the clinically relevant range in 92.2% (95% CI, 90.3%-94.0%). The correlation coefficient for age to anesthesiologist-selected ideal ETT size was strong for both normal and PSS patients (r = 0.91 and r = 0.93, respectively). Length was also highly correlated to actual ETT size used for both groups (r = .91).
Length-based prediction of ETT size is at least as accurate as age-based estimation in both normal and pathologically short children.
在患有影响正常生长的疾病（即病理性身材矮小，PSS）的儿童中，比较基于长度的气管内导管（ETT）尺寸估计值和基于年龄的估计值与麻醉医生选择的理想ETT尺寸。
我们对3年内所有因任何外科手术接受气管插管的儿童的麻醉数据库进行了回顾性研究。麻醉医生选择的理想ETT尺寸定义为在一名获得委员会认证的儿科麻醉医生监督下，在整个病例中选择并成功使用的尺寸。使用漏气试验和充分的氧合/通气等客观标准来验证所选ETT的合适性。为了进行分析，将儿童分为年龄别身长正常组和PSS组，PSS定义为在疾病控制和预防中心生长图表上低于年龄别身长的5%。然后比较每组中基于年龄和基于长度的公式，在麻醉医生选择的理想ETT尺寸的±0.5毫米范围内的临床相关预测ETT的比例。
分析了5175份患者记录。在身材正常的儿童中，基于年龄预测的ETT尺寸在临床相关范围内的比例为89.8%（95%置信区间[CI]，88.9%-90.7%），基于长度预测的ETT尺寸在临床相关范围内的比例为92.8%（95%CI，92.0%-93.6%）。在患有PSS的儿童中，基于年龄预测的ETT尺寸在临床相关范围内的比例为86.6%（95%CI，84.3%-89.0%），基于长度预测的ETT尺寸在临床相关范围内的比例为92.2%（95%CI，90.3%-94.0%）。对于正常和PSS患者，年龄与麻醉医生选择的理想ETT尺寸之间的相关系数都很强（分别为r = 0.91和r = 0.93）。长度与两组实际使用的ETT尺寸也高度相关（r = 0.91）。
在正常儿童和病理性身材矮小的儿童中，基于长度预测ETT尺寸至少与基于年龄的估计一样准确。
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