Ajou University School of Medicine, Department of Emergency Medicine, Suwon, Korea.
Ajou University School of Medicine, Department of Anesthesiology, Suwon, Korea.
West J Emerg Med. 2023 Apr 28;24(3):579-587. doi: 10.5811/westjem.59560.
A young child's larynx was formerly believed to be narrowest at the cricoid level, circular in section, and funnel shaped. This supported the routine use of uncuffed endotracheal tubes (ETTs) in young children despite the benefits of cuffed ETTs, such as lower risk for air leakage and aspiration. In the late 1990s, evidence supporting the pediatric use of cuffed tubes emerged largely from anesthesiology studies, while some technical flaws of the tubes remained a concern. Since the 2000s, imaging-based studies have clarified laryngeal anatomy, revealing that it is narrowest at the glottis, elliptical in section, and cylindrical in shape. The update was contemporaneous with technical advances in the design, size, and material of cuffed tubes. The American Heart Association currently recommends the pediatric use of cuffed tubes. In this review, we present the rationale for using cuffed ETTs in young children based on our updated knowledge of pediatric anatomy and technical advances.
以前人们认为幼儿的喉部在环状软骨水平最窄，呈圆形，呈漏斗状。这支持了在幼儿中常规使用无套囊气管内导管（ETT），尽管有套囊 ETT 的好处，如降低漏气和误吸的风险。在 20 世纪 90 年代后期，主要来自麻醉学研究的证据支持儿科使用带套囊的管子，而管子的一些技术缺陷仍然令人关注。自 21 世纪以来，基于影像学的研究已经阐明了喉部解剖结构，表明它在声门处最窄，呈椭圆形，呈圆柱形。这一更新与带套囊管子的设计、尺寸和材料的技术进步同步。美国心脏协会目前建议在儿科使用带套囊的管子。在这篇综述中，我们根据我们对儿科解剖结构和技术进步的最新认识，提出了在幼儿中使用带套囊 ETT 的基本原理。
