Altun Demet, Sungur Mukadder Orhan, Ali Achmet, Bingül Emre Sertaç, Seyhan Tülay Özkan, Çamcı Emre
Department of Anaesthesiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey.
Turk J Anaesthesiol Reanim. 2016 Dec;44(6):301-305. doi: 10.5152/TJAR.2016.60420. Epub 2016 Dec 1.
The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size.
Fifty children who were 1-10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm HO, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm HO, if a seal could not be achieved with a cuff pressure of >25 cm HO or if a peak airway pressure of >25 cm HO was observed during ventilation, the tube was changed to a tube one size larger. The OD of the best-fit ETT was converted to the ID. The best-fit ID, the requirement for ETT replacement, the duration of airway diameter measurement by USG and the peak airway pressure were recorded.
The success rate of the first attempt with USG was 86%; the ETT was replaced in five patients with a tube one size larger and in two patients with a tube one size smaller.
Our findings show the subglottic diameter measured by USG to be a reliable predictor in estimating the appropriate paediatric ETT size.
本可行性研究的目的是调查超声检查（USG）首次尝试成功预测小儿患者合适的带套囊气管内插管（ETT）尺寸的情况。
选取50例年龄在1至10岁之间、因腺样体切除术或腺样体扁桃体切除术接受气管插管全身麻醉的儿童纳入研究。在所有参与者中，于环状软骨水平在未通气状态下用USG测量声门下气道的横径。根据测得的声门下气道直径选择最大允许ETT的外径（OD）。若插管进入气管时有阻力，或气道压力>25 cm H₂O时无明显漏气声，则将ETT更换为内径（ID）小0.5 mm的气管导管。若气道压力<10 cm H₂O时有明显漏气声，或套囊压力>25 cm H₂O时无法实现密封，或通气期间观察到气道峰值压力>25 cm H₂O，则将气管导管更换为大一号的导管。将最适配ETT的OD换算为ID。记录最适配的ID、ETT更换需求、USG测量气道直径的持续时间以及气道峰值压力。
USG首次尝试的成功率为86%；5例患者将ETT更换为大一号的导管，2例患者更换为小一号的导管。
我们的研究结果表明，通过USG测量的声门下直径是估计小儿合适ETT尺寸的可靠预测指标。
