Department of Anaesthesiology, University Medical Centre Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany.
Department of Neuroradiology, University Medical Centre Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany.
Resuscitation. 2021 Nov;168:95-102. doi: 10.1016/j.resuscitation.2021.09.024. Epub 2021 Sep 30.
To determine the accuracy of the recently proposed landmark-method 'nostril-to-tragus minus 10 mm' and compare with ERC-recommended distances for nasopharyngeal airway length sizing in children.
We conducted a prospective observational study in sedated children < 12 years. Nasopharyngeal airways were inserted following 'nostril-to-tragus minus 10 mm'. Primary outcome was the rate of nasopharyngeal airway tips between soft palate and epiglottis on magnetic resonance imaging (MRI) indicated for medical reasons. An optimal placement was defined when the tip lied within 25-75% of the total soft palate-to-epiglottis distance. Between 0-100% of this distance, placement was still considered acceptable, below 0% too proximal or above 100% too distal. Secondary outcomes were the rate of adverse events, the qualitative positions of airway tips, and the comparison of ́nostril-to-tragus minus 10 mḿ with the ERC-recommended distances 'nostril-to-angle of the mandible' and 'nostril-to-tragus' with objective MRI measurements.
We analysed 92 patients with a mean age of 4.3 years. Nasopharyngeal airways were optimally placed in 37.0% (8.7% too proximal-77.2% acceptable-14.1% too distal). Three qualitative malpositions, but no airway-associated adverse event occurred. Objective measurements on MRI revealed the probability of 40.2% optimally placed nasopharyngeal airways (5.4%-67.4%-27.2%) for 'nostril-to-tragus minus 10 mm', 38.0% (17.4%-58.7%-23.9%) for 'nostril-to-mandible' and 13.0% (0%-28.3%-71.7%) for 'nostril-to-tragus', respectively.
No landmark-method predicted nasopharyngeal airway position reliably. 'Nostril-to-tragus minus 10 mm' seems the least inaccurate one and could be a valuable approximation until another estimation-formula proves more accurate. During insertion, careful clinical evaluation of airway patency is crucial.
German Clinical Trials Register; DRKS00021007.
确定最近提出的“鼻翼至耳屏下 10 毫米”标记法的准确性，并与 ERC 推荐的用于儿童鼻咽气道长度测量的距离进行比较。
我们对镇静儿童（<12 岁）进行了一项前瞻性观察研究。在 MRI 提示的医学原因下，使用“鼻翼至耳屏下 10 毫米”的方法插入鼻咽气道。主要结果是磁共振成像（MRI）上显示鼻咽气道尖端位于软腭和会厌之间的比例。当尖端位于软腭-会厌总距离的 25%-75%之间时，定义为最佳位置。在 0%-100%之间的位置仍被认为是可以接受的，低于 0%的位置太靠近前端，高于 100%的位置太靠后。次要结果是不良事件的发生率、气道尖端的定性位置，以及“鼻翼至耳屏下 10 毫米”与 ERC 推荐的“鼻翼至下颌角”和“鼻翼至耳屏”距离与客观 MRI 测量值的比较。
我们分析了 92 名平均年龄为 4.3 岁的患者。37.0%（8.7%太靠前-77.2%可接受-14.1%太靠后）的鼻咽气道处于最佳位置。有 3 个定性位置不当，但没有发生与气道相关的不良事件。MRI 上的客观测量显示，对于“鼻翼至耳屏下 10 毫米”，40.2%的鼻咽气道处于最佳位置（4.0%-67.4%-27.2%），对于“鼻翼至下颌角”，38.0%（17.4%-58.7%-23.9%），对于“鼻翼至耳屏”，13.0%（0%-28.3%-71.7%）。
没有一种标记法能可靠地预测鼻咽气道的位置。“鼻翼至耳屏下 10 毫米”似乎是最不准确的方法之一，在另一种更准确的估算公式出现之前，可以作为一种有价值的近似方法。在插入过程中，仔细评估气道通畅性至关重要。
德国临床试验注册中心；DRKS00021007。
