Department of Otolaryngology - Head and Neck Surgery, Penn State Health, Milton S. Hershey Medical Center, 500 University Drive, P.O Box 850, MC H091, Hershey, 17033, PA, USA.
Department of Radiology, Penn State Health, Milton S. Hershey Medical Center, 500 University Drive, P.O Box 850, Hershey, 17033, PA, USA.
Int J Pediatr Otorhinolaryngol. 2021 Feb;141:110566. doi: 10.1016/j.ijporl.2020.110566. Epub 2020 Dec 15.
To compare tracheoscopy and chest radiograph measurements of tracheostomy tube position in infants.
Retrospective chart review.
Otolaryngology Department at Penn State Milton S. Hershey Medical Center.
All cases of pediatric patients who underwent tracheotomy at less than 1 year of age from 2014 to 2019 were reviewed. Patients were included if they had both intraoperative measurement of tracheostomy tube position relative to the carina by tracheoscopy and postoperative chest radiograph. Documented intraoperative findings were compared to measurements made on chest radiograph by an attending radiologist blinded to the intraoperative measurements.
The study included 66 patients; 30 patients (14:16, M:F) had available data. The mean distance from the distal tracheostomy tube to the carina measured by tracheoscopy was 8.88 mm (range, 3.5-20 mm) and measured radiographically was 11.71 mm (range, 2.4-23.3 mm). The mean difference between the measurements was 2.82 mm (p-value = 0.016). Ninety percent (n = 27) of patients had measurements that differed by greater than 2 mm; 53% (n = 16) had measurements that differed by 5 mm and 1% (n = 3) had measurements differing by greater than 10 mm.
In the infant population, significant discrepancy was found between direct tracheoscopy and chest radiograph measurements of the tracheostomy tube position. Measurements obtained by chest radiographs tend to overestimate the relative distance of the distal tracheostomy tube to the carina as compared to that of tracheoscopy. Clinical decisions regarding changes to tracheostomy tube sizes should mostly rely on tracheoscopy performed with the patient supine.
比较婴儿气管切开术位置的气管镜和胸部 X 线片测量。
回顾性图表回顾。
宾夕法尼亚州立大学 Milton S. Hershey 医疗中心耳鼻喉科。
回顾了 2014 年至 2019 年间在 1 岁以下接受气管切开术的所有儿科患者的病例。如果患者在手术中通过气管镜测量气管切开管相对于隆突的位置，并且术后有胸部 X 线片，则将患者纳入研究。将记录的术中发现与由对术中测量结果不知情的主治放射科医生在胸部 X 线上进行的测量进行比较。
该研究纳入了 66 名患者；30 名患者（14:16，男：女）有可用数据。通过气管镜测量的远端气管切开管到隆突的平均距离为 8.88 毫米（范围，3.5-20 毫米），通过 X 线片测量的距离为 11.71 毫米（范围，2.4-23.3 毫米）。测量值之间的平均差异为 2.82 毫米（p 值=0.016）。90%（n=27）的患者测量值相差大于 2 毫米；53%（n=16）的患者测量值相差 5 毫米，1%（n=3）的患者测量值相差大于 10 毫米。
在婴儿人群中，直接气管镜和胸部 X 线片测量气管切开管位置之间存在显著差异。与气管镜相比，胸部 X 线片测量得到的位置往往高估了远端气管切开管相对于隆突的相对距离。关于气管切开管大小改变的临床决策应主要依赖于患者仰卧位时进行的气管镜检查。
