环状软骨和气管长度：预测插管深度以预防声门下狭窄。

Length of the Cricoid and Trachea in Children: Predicting Intubation Depth to Prevent Subglottic Stenosis.

机构信息

Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

出版信息

Laryngoscope. 2022 Jan;132 Suppl 2:S1-S10. doi: 10.1002/lary.29616. Epub 2021 May 11.

DOI:10.1002/lary.29616

PMID:33973659

Abstract

OBJECTIVE

Define the length of the subglottis and trachea in children to predict a safe intubation depth.

METHODS

Patients <18 years undergoing rigid bronchoscopy from 2013 to 2020 were included. The carina and inferior borders of the cricoid and true vocal folds were marked on a bronchoscope and distances were measured. Patient age, weight, height, and chest height were recorded. Four styles of cuffed pediatric endotracheal tubes (ETT) were measured and potential positions of each cuff and tip were calculated within each trachea using five depth of intubation scenarios. Multivariate linear regression was performed to identify predictors of subglottic and tracheal length.

RESULTS

Measurements were obtained from 210 children (141 male, 69 female), mean (SD) age 3.21 (3.66) years. Patient height was the best predictor of subglottic length (R : 0.418): Length (mm) = 0.058 * height (cm) + 2.8, and tracheal length (R : 0.733): Length (mm) = 0.485 * height (cm) + 21.3. None of the depth of intubation scenarios maintained a cuff-free subglottis for all ETT styles investigated. A formula for depth of intubation: Length (mm) = 0.06 * height (cm) + 8.8 found that no ETT cuffs would be in the subglottis and all tips would be above the carina.

CONCLUSION

Current strategies for determining appropriate depth of intubation pose a high risk of subglottic ETT cuff placement. Placing the inferior border of the vocal cords 0.06 * height (cm) + 8.8 from the superior border of the inflated ETT cuff may prevent subglottic cuff placement and endobronchial intubation.

LEVEL OF EVIDENCE

4 Laryngoscope, 132:S1-S10, 2022.

摘要

目的

确定儿童的声门下区和气管长度，以预测安全的插管深度。

方法

纳入 2013 年至 2020 年间进行硬性支气管镜检查的<18 岁患者。在支气管镜上标记隆突和环状软骨的下边界以及真声带，并测量距离。记录患者的年龄、体重、身高和胸部高度。测量了四种类型的带套小儿气管内导管（ETT），并在五种插管深度场景下计算了每个气管内的每个套囊和尖端的潜在位置。采用多元线性回归分析确定声门下区和气管长度的预测因子。

结果

共获得 210 名儿童（141 名男性，69 名女性）的测量值，平均（SD）年龄为 3.21（3.66）岁。患者身高是声门下区长度的最佳预测因子（R：0.418）：长度（mm）=0.058身高（cm）+2.8，气管长度（R：0.733）：长度（mm）=0.485身高（cm）+21.3。在所研究的所有 ETT 类型中，没有一种插管深度情景能保持所有 ETT 套囊都在声门下区。一个插管深度公式：长度（mm）=0.06*身高（cm）+8.8 发现，没有 ETT 套囊会位于声门下区，并且所有尖端都会位于隆突上方。