Altun Demet, Orhan-Sungur Mukadder, Ali Achmet, Özkan-Seyhan Tülay, Sivrikoz Nükhet, Çamcı Emre
Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Paediatr Anaesth. 2017 Oct;27(10):1015-1020. doi: 10.1111/pan.13220. Epub 2017 Aug 28.
The aim of this prospective study was to investigate the success of ultrasound in pediatric patients in determining the appropriate sized cuffed endotracheal tube and to compare the results with conventional height-based (Broselow) tape and age-based formula tube size.
One hundred and fifty-two children of 1-10 years of age, who received general anesthesia for adenotonsillectomy were enrolled to the study. In all participants, the transverse diameter of the subglottis was measured with ultrasound during apnea. An endotracheal tube was chosen with the outer diameter matched to the measured subglottic airway diameter. An age-based (Motoyama-Khine) and height-based (Broselow) endotracheal tube size was calculated. If there was resistance to passage of the tube into the trachea or an airway pressure >25 cmH 0 was required to detect an audible leak, the endotracheal tube was replaced with internal diameter of 0.5 mm smaller. If there was an audible leak at airway pressure <10 cmH O, or peak pressure >25 cmH 0 or a cuff pressure > 25 cmH O was required to seal, the tube was changed to the 0.5 mm larger internal diameter. Best-fit tube internal diameter was the resultant tube internal diameter that met the previously stated conditions. The need for endotracheal tube replacement and peak airway pressure were recorded.
The internal diameter of ultrasound determined tube was the same as best-fit tube in 88% of children. Endotracheal tube was replaced in 15 patients with a one size larger, and in three patients with one size smaller tube. Using Bland-Altman analysis, a better agreement was observed with ultrasound measurement rather than height-based estimation and age-based formulas.
Our findings show that subglottic diameter measured by ultrasound appears to be a reliable predictor for the assessment of the subglottic diameter of the airway in estimating appropriate size pediatric endotracheal tube.
这项前瞻性研究的目的是调查超声在确定小儿患者合适尺寸带套囊气管内导管方面的成功率，并将结果与传统的基于身高（ Broselow ）的胶带和基于年龄的公式计算的导管尺寸进行比较。
152名1至10岁接受腺样体扁桃体切除术全身麻醉的儿童纳入本研究。在所有参与者中，在呼吸暂停期间用超声测量声门下横径。选择外径与测量的声门下气道直径匹配的气管内导管。计算基于年龄（Motoyama-Khine）和基于身高（Broselow）的气管内导管尺寸。如果导管插入气管时有阻力，或者需要气道压力>25 cmH₂O才能检测到可闻及的漏气，则将气管内导管更换为内径小0.5 mm的导管。如果在气道压力<10 cmH₂O时存在可闻及的漏气，或者需要峰值压力>25 cmH₂O或套囊压力>25 cmH₂O才能密封，则将导管更换为内径大0.5 mm的导管。最佳拟合导管内径是符合先前所述条件的最终导管内径。记录气管内导管更换的必要性和气道峰值压力。
88%的儿童中，超声确定的导管内径与最佳拟合导管相同。15例患者更换为大一号的气管内导管，3例患者更换为小一号的气管内导管。使用Bland-Altman分析，与基于身高的估计和基于年龄的公式相比，超声测量的一致性更好。
我们的研究结果表明，超声测量的声门下直径似乎是评估气道声门下直径以估计合适尺寸小儿气管内导管的可靠预测指标。
