Dalal Priti G, Murray David, Feng Angela, Molter David, McAllister John
Department of Anesthesiology, Penn State Milton S Hershey Medical Center, Hershey, PA, USA.
Paediatr Anaesth. 2008 Jul;18(7):645-53. doi: 10.1111/j.1460-9592.2008.02533.x. Epub 2008 May 8.
Pediatric airway management decisions are based primarily on results derived from indirect measures of laryngeal and tracheal dimensions. More recent methods could provide more direct information about absolute and relative changes in airway dimensions associated with growth and development.
The aims of this study were (i) to determine whether a 'video-bronchoscopic' measurement method could be used to reliably measure airway dimensions in children and (ii) to provide a preliminary assessment of dimensions of the glottis and cricoid in children of various ages.
Following approval from the institutional review board, validation experiments were performed to determine whether measurements obtained from the video image from the bronchoscope provided accurate measurements of tubular objects of known dimensions. The reliability of the measurements was determined by using two independent trained observers to measure video-bronchoscopic images of the larynx at the level of the glottis and the cricoid in 11 children. The observers measured the video-bronchoscopic images and airway measurements were obtained in 16 additional children to determine the utility of the measurement method.
There was good agreement between the direct and video-bronchoscopic measurement techniques (Bland and Altman plot) for both the cross-sectional area (CSA) and the diameter of objects. The interobserver measures for cricoid and glottis were reproducible as indicated by the concordance correlation coefficient (CCC) for cricoid anteroposterior diameter (CCC = 0.98, r = 0.98, accuracy = 0.99) and transverse diameter (CCC = 0.93, r = 0.8, accuracy = 0.99) as well as for the glottic anteroposterior diameter (r = 0.8, accuracy = 0.8, CCC = 0.6) and the glottic transverse diameter(r = 0.8, accuracy = 0.74, CCC = 0.6). Overall, for the 27 children studied [mean age 73 months (+/-24.7, range 30-140], the mean value of the cricoid CSA [45.3 mm(2) (+/-13.9)] was found to be greater than the glottic CSA [16.2 mm(2) (+/-10.1)].
The video-bronchoscopic imaging method provided an accurate, reliable measure of pediatric airway dimensions. This technique could be applied to assess absolute and relative airway size associated with growth and development. The relationship between glottic and cricoid dimensions during growth and development in children needs further investigation across various age groups.
儿科气道管理决策主要基于从喉和气管尺寸的间接测量得出的结果。最新方法可以提供有关与生长发育相关的气道尺寸绝对和相对变化的更直接信息。
本研究的目的是（i）确定“视频支气管镜”测量方法是否可用于可靠地测量儿童气道尺寸，以及（ii）对不同年龄段儿童的声门和环状软骨尺寸进行初步评估。
经机构审查委员会批准后，进行了验证实验，以确定从支气管镜视频图像获得的测量值是否能准确测量已知尺寸的管状物体。通过使用两名经过独立培训的观察者测量11名儿童声门和环状软骨水平的喉部视频支气管镜图像，来确定测量的可靠性。观察者测量视频支气管镜图像，并在另外16名儿童中进行气道测量，以确定该测量方法的实用性。
对于物体的横截面积（CSA）和直径，直接测量技术与视频支气管镜测量技术之间（Bland和Altman图）具有良好的一致性。环状软骨和声门的观察者间测量结果具有可重复性，环状软骨前后径的一致性相关系数（CCC）表明了这一点（CCC = 0.98，r = 0.98，准确度 = 0.99）以及横径（CCC = 0.93，r = 0.8，准确度 = 0.99），声门前、后径（r = 0.8，准确度 = 0.8，CCC = 0.6）和声门横径（r = 0.8，准确度 = 0.74，CCC = 0.6）也是如此。总体而言，对于所研究的27名儿童[平均年龄73个月（±24.7，范围30 - 140）]，发现环状软骨CSA的平均值[45.3平方毫米（±13.9）]大于声门CSA[16.2平方毫米（±10.1）]。
视频支气管镜成像方法为儿科气道尺寸提供了准确、可靠的测量。该技术可用于评估与生长发育相关的气道绝对和相对大小。儿童生长发育过程中声门和环状软骨尺寸之间的关系需要在不同年龄组中进一步研究。
