Tupprasoot Raksa, Langan Dean, Hutchinson J Ciaran, Barrett Hannah, Sury Michael R J, Arthurs Owen J
Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Neonatology. 2017;111(4):376-382. doi: 10.1159/000455036. Epub 2017 Feb 1.
Positioning a tracheal tube (TT) to the correct depth in preterm infants is challenging. Currently, there is no reliable single-predictor model for neonates applicable to the whole range of size or age.
In this study, we used post-mortem magnetic resonance imaging (PMMRI) of preterm infants to measure tracheal dimensions and to develop a clinical guide for TT positioning.
We measured tracheal length (TL) and tracheal diameter (TD) in a cohort of normal neonates and foetuses that underwent PMMRI (cause of death unexplained). The distance between the lips and the mid-tracheal point, i.e., the mid-tracheal length (mid-TL), and the TD measurement were obtained. We produced univariate prediction models of mid-TL and TD, using gestational age (GA), foot length (FL), crown-rump length (CRL) and body weight (BW) as potential predictors, as well as multiple prediction models for mid-TL.
Tracheal measurements were performed in 117 cases, with a mean GA of 28.8 weeks (range 14-42 weeks). The best linear association was between mid-TL and FL (mid-TL = FL × 0.914 + 1.859; R2 = 0.94), but was improved by multivariate regression models. We developed a prediction tool using only GA and BW (R2 = 0.92), and all four predictors (GA, BW, FL and CRL; R2 = 0.94) which is now available as a web-based application via the Internet.
Post-mortem imaging data provide estimates of TT insertion depth. Our prediction tool based on age and BW can be used at the bedside and is ready to be tested in clinical practice.
将气管导管（TT）放置到早产儿的正确深度具有挑战性。目前，尚无适用于所有大小或年龄范围的可靠新生儿单预测模型。
在本研究中，我们使用早产儿的尸检磁共振成像（PMMRI）来测量气管尺寸，并制定TT定位的临床指南。
我们在一组接受PMMRI（死因不明）的正常新生儿和胎儿中测量了气管长度（TL）和气管直径（TD）。获得了嘴唇与气管中点之间的距离，即气管中点长度（mid-TL），以及TD测量值。我们使用胎龄（GA）、足长（FL）、顶臀长（CRL）和体重（BW）作为潜在预测指标，建立了mid-TL和TD的单变量预测模型，以及mid-TL的多变量预测模型。
对117例病例进行了气管测量，平均GA为28.8周（范围14 - 42周）。mid-TL与FL之间的线性关联最佳（mid-TL = FL×0.914 + 1.859；R2 = 0.94），但通过多变量回归模型有所改善。我们开发了仅使用GA和BW的预测工具（R2 = 0.92），以及使用所有四个预测指标（GA、BW、FL和CRL；R2 = 0.94）的预测工具，现在可通过互联网作为基于网络的应用程序获取。
尸检成像数据提供了TT插入深度的估计值。我们基于年龄和BW的预测工具可在床边使用，并准备好在临床实践中进行测试。
