Saravia Ari, Saravia Rachel W, Mudd Pamela, Jones Joel W
Louisiana State University School of Medicine, New Orleans, Louisiana, USA; Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Louisiana State University School of Medicine, New Orleans, Louisiana, USA.
Int J Pediatr Otorhinolaryngol. 2023 Mar;166:111482. doi: 10.1016/j.ijporl.2023.111482. Epub 2023 Feb 9.
The purpose of this review was to determine the ability of ultrasound (US) to assess the subglottic airway in pediatric patients to estimate the appropriate size of endotracheal tube (ETT).
Pubmed, Scopus, and Embase databases.
A search of the literature was performed for studies that utilized ultrasonography to examine the minimal transverse diameter of the subglottic airway (MTDSA) in the pediatric (age < 18) population to estimate endotracheal tube (ETT) size. Articles were excluded if they involved adults or non-humans, had no comparison method, or were case reports. The primary outcome was the successful use of ultrasound compared to the reference standard defined by the study.
Sixteen studies were included, for a total of 1,633 pediatric subjects in whom transcervical laryngeal ultrasound was used prospectively to examine the MTDSA to estimate ETT size prior to intubation. Ultrasound reliably predicted the clinically best fit endotracheal tube by air leak test in 48-100% of subjects, while age-based formulas were accurate 24-95% of the time. Ultrasound was highly predictive of proper size, with R2 ranging between 0.684 to 0.980. Of those reintubated (n = 104), 86 (83%) required larger-sized tubes, while 18 (17%) required smaller-sized tubes. Both methods tended to underestimate ETT size, but the age-based formulas accounted for most of these differences.
Transcervical laryngeal ultrasound appears to be a reliable predictor of endotracheal tube size in children undergoing elective surgery, which has implications for preventing intubation-related trauma and ensuring adequate ventilation for those who may require prolonged intubation.
本综述的目的是确定超声（US）评估儿科患者声门下气道以估计合适气管内导管（ETT）尺寸的能力。
PubMed、Scopus和Embase数据库。
对利用超声检查儿科（年龄<18岁）人群声门下气道最小横径（MTDSA）以估计气管内导管（ETT）尺寸的研究进行文献检索。如果文章涉及成人或非人类、没有比较方法或为病例报告，则将其排除。主要结果是与研究定义的参考标准相比，超声的成功应用。
纳入16项研究，共1633名儿科受试者，前瞻性地使用经颈喉超声检查MTDSA以在插管前估计ETT尺寸。超声通过漏气试验在48%-100%的受试者中可靠地预测了临床上最合适的气管内导管，而基于年龄的公式在24%-95%的时间内是准确的。超声对合适尺寸具有高度预测性，R2范围在0.684至0.980之间。在再次插管的患者中（n = 104），86名（83%）需要更大尺寸的导管，而18名（17%）需要更小尺寸的导管。两种方法都倾向于低估ETT尺寸，但基于年龄的公式占了这些差异的大部分。
经颈喉超声似乎是择期手术儿童气管内导管尺寸的可靠预测指标，这对于预防插管相关创伤以及确保可能需要长时间插管的患者获得充分通气具有重要意义。
