Pei Bei, Jin Chenyu, Cao Shuang, Eckle Tobias, Park Hue Jung, Ji Ningning, Jiang Hong, Xia Ming
Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Transl Pediatr. 2023 Dec 26;12(12):2222-2231. doi: 10.21037/tp-23-502. Epub 2023 Dec 13.
Selecting the optimal tracheal tube size is critically important for pediatric patients. Age-based formulas are often used, but still have limitations. The aim of this prospective study was to investigate whether middle finger measurements correlate with cuffed tracheal tube size and to further develop a prediction model based on these measurements.
Patients under 12 years of age scheduled for elective surgery involving tracheal intubation were enrolled in the study. The length was determined from the tip of the distal metacarpal to the palm's root on the palm side, while the circumference was measured at the base of the palm using a soft tape measure. The appropriate cuffed tracheal tube size was determined based on specific criteria. If the tube encountered resistance during insertion or required an airway pressure >25 cmHO to detect an audible leak, it was replaced with a tube 0.5 mm smaller. Conversely, if an audible leak occurred at an airway pressure <10 cmHO, or peak pressure >25 cmHO, or the cuff pressure >25 cmHO to achieve a seal, the tube was exchanged for one with a 0.5 mm larger. Linear regression analysis was used to examine the association between middle finger circumference and length with the cuffed tracheal tube size. Subsequently, regression equations were constructed based on the results of the linear regression analysis and their predictive performance was compared to the conventional age-based formulas, including the Khine formula and Motoyama formula. The predictive performance was evaluated by mean absolute error (MAE), root mean square error (RMSE), and prediction accuracy.
A total of 261 patients were analyzed in our study. The mean age of the patients was 46.19±35.83 months. The linear relationship was observed between the cuffed tracheal tube size and the middle finger circumference and middle finger length with R values of 0.77 and 0.73, respectively. In comparison to conventional age-based formulas, both middle finger circumference and middle finger length demonstrated superior predictive performance, characterized by lower MAE and RMSE, as well as higher prediction accuracy. Notably, the regression equation based on the middle finger circumference obtained the higher predictive accuracy of 0.590, with an MAE of 0.259 and an RMSE of 0.333 as opposed to the predictive accuracy of 0.391, MAE of 0.349, and RMSE of 0.473 derived from conventional age-based formulas. Based on the regression coefficients of linear regression, simplified formulas were proposed, with the middle finger circumference-based formula emerging as the most accurate and simple option.
The appropriate cuffed tracheal tube size could be predicted by the middle finger circumference. Our proposed formula 'cuffed tracheal tube internal diameter (mm) = middle finger circumference (cm) - 0.2' has the potential to improve the selection of the cuffed tracheal tube size in pediatric patients.
选择最佳气管导管尺寸对儿科患者至关重要。基于年龄的公式经常被使用，但仍有局限性。这项前瞻性研究的目的是调查中指测量值是否与带套囊气管导管尺寸相关，并基于这些测量值进一步开发预测模型。
纳入计划进行涉及气管插管的择期手术的12岁以下患者。长度是从远端掌骨尖端到手掌侧手掌根部测定，而周长是使用软卷尺在手掌基部测量。根据特定标准确定合适的带套囊气管导管尺寸。如果导管插入过程中遇到阻力或需要气道压力>25 cmH₂O才能检测到可闻及的漏气，则更换为小0.5 mm的导管。相反，如果在气道压力<10 cmH₂O时出现可闻及的漏气，或峰值压力>25 cmH₂O，或套囊压力>25 cmH₂O才能实现密封，则将导管更换为大0.5 mm的导管。使用线性回归分析来检查中指周长和长度与带套囊气管导管尺寸之间的关联。随后，根据线性回归分析结果构建回归方程，并将其预测性能与传统的基于年龄的公式（包括Khine公式和Motoyama公式）进行比较。通过平均绝对误差（MAE）、均方根误差（RMSE）和预测准确性来评估预测性能。
本研究共分析了261例患者。患者的平均年龄为46.19±35.83个月。观察到带套囊气管导管尺寸与中指周长和中指长度之间存在线性关系，R值分别为0.77和0.73。与传统的基于年龄的公式相比，中指周长和中指长度均表现出更好的预测性能，其特点是MAE和RMSE较低，以及预测准确性较高。值得注意的是，基于中指周长的回归方程获得了更高的预测准确性0.590，MAE为0.259，RMSE为0.333，而传统基于年龄的公式的预测准确性为0.391，MAE为0.349，RMSE为0.473。基于线性回归的回归系数，提出了简化公式，其中基于中指周长的公式是最准确和简单的选择。
可以通过中指周长预测合适的带套囊气管导管尺寸。我们提出的公式“带套囊气管导管内径（mm）=中指周长（cm）-0.2”有可能改善儿科患者带套囊气管导管尺寸的选择。
