Bhut Archan Jayantbhai, Patil Kalyani Nilesh, Swami Sarita
Bharati Hospital, Bharati Vidyapeeth (Deemed to be University) Medical College, Clinic of Anaesthesiology and Reanimation, Pune, India.
Turk J Anaesthesiol Reanim. 2025 Mar 21;53(2):69-76. doi: 10.4274/TJAR.2025.241822.
In the paediatric population, the selection of an appropriately sized endotracheal tube (ETT) is extremely important not only to ensure adequate ventilation but also to avoid post-extubation stridor and stenosis. Conventionally, formulas based on age, height, or weight are used to determine the most appropriate size. In this study, we compared ultrasonography (USG) and age-based formula for predicting the best microcuff ETT size in paediatric patients aged 1-5 years.
One hundred eighteen patients, aged 1 to 5 years, with American Society of Anesthesiologists, classifications of I or II, were included. After standard general anaesthesia protocols, the subglottic diameter was assessed by USG. Intubation was performed using ETT size according to age-based formula. The best clinical fit was determined after the leak test. The internal and external diameters of the ETTs were predicted by both methods and correlated with the best-fit ETT sizes used during the procedures using Pearson's correlation. Cohen's kappa was used for statistical agreement between two methods.
USG had a significantly higher correlation with the best-fit model as compared to the age-based formula, with 99.2% and 77.1% agreement rates. The best-fit ETT showed a better correlation with the USG-guided estimate (r = 0.994, < 0.001). The Cohen's Kappa value of 0.986 showed a statistically significantly higher agreement between USG-guided estimate and best-fit ETT.
USG-guided estimation of subglottic diameter is a better predictor for optimally sized microcuff ETT than the age-based formula in the paediatric age group of 1-5 years. 22% of tube changes could have been prevented with ultrasound-guidance as a primary approach for estimating ETT size.
在儿科人群中，选择尺寸合适的气管内导管（ETT）极为重要，这不仅是为了确保充足的通气，也是为了避免拔管后喘鸣和狭窄。传统上，基于年龄、身高或体重的公式用于确定最合适的尺寸。在本研究中，我们比较了超声检查（USG）和基于年龄的公式在预测1至5岁儿科患者最佳微囊ETT尺寸方面的效果。
纳入118例年龄在1至5岁、美国麻醉医师协会分级为I或II级的患者。按照标准全身麻醉方案实施麻醉后，通过超声检查评估声门下直径。根据基于年龄的公式使用相应尺寸的ETT进行插管。在漏气试验后确定最佳临床适配情况。两种方法都对ETT的内径和外径进行了预测，并使用Pearson相关性分析将其与手术过程中使用的最佳适配ETT尺寸进行关联。使用Cohen's kappa分析两种方法之间的统计一致性。
与基于年龄的公式相比，超声检查与最佳适配模型的相关性显著更高，一致率分别为99.2%和77.1%。最佳适配ETT与超声引导下的估计值显示出更好的相关性（r = 0.994，P < 0.001）。Cohen's Kappa值为0.986，表明超声引导下的估计值与最佳适配ETT之间在统计学上具有显著更高的一致性。
在1至5岁的儿科年龄组中，对于最佳尺寸的微囊ETT，超声引导下估计声门下直径比基于年龄的公式是更好的预测指标。作为估计ETT尺寸的主要方法，超声引导可避免22%的导管更换。
