Accuracy of ultrasound to measure the cricoid cartilage diameter in children

Hao, Jingcan; Zhang, Jie; Wu, Zanqing; Cai, Wenbo; Dong, Birong; Luo, Zhenguo

doi:10.1111/aas.13687

Cited by 4 publications

(4 citation statements)

References 13 publications

(16 reference statements)

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“…Taking into account that outer diameter (OD) is decisive for optimal fit of ETTs, direct measurement of trachea should be more informative. Direct measurement of tracheal width by different methods can be used for estimation (17)(18)(19) . USG, as an option in these methods, provide a bedside tool to measure subglottic diameter to obtain reliable and consistent values among patients.…”

Section: Discussionmentioning

confidence: 99%

Estimation of Appropriate Endotracheal Tube Size in Pediatric Patients: Use of Epiphyseal Diameter of the Distal Radius and Subglottic Diameter

Altun¹,

Doruk²,

Dinçer³

et al. 2021

Jarss

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INTRODUCTION: The aim of this study is to test the usefulness of epiphysis of distal radius measurement as a surrogate parameter for endotracheal tube (ETT) size prediction in children. METHODS: Seventy-three children were intubated with cuffed ETT selected according to age-based formula. Transvers diameter of epiphysis of distal radius and subglottic diameter of trachea were measured by ultrasound (US). Correlation between the outer diameter of best-fit endotracheal tube and transvers diameter of both radius epiphysis and subglottic diameter were calculated. The need for tube exchange, time for ultrasound (US) measurements and the ease level of measurements were compared. RESULTS: First attempt success at intubation was 83.6%. The correlation of the epiphysis diameter of the distal radius and best-fit ETT was significant (p<0.001, r= 0.619, r2=0.383, 95% CI=0.419-0.838). Similarly the correlation of subglottic tracheal diameter and best-fit ETT was significant (p<0.001, r=0.744, r2=0.553, 95% CI=0.678-825). Estimated ETT sizes according to radial epiphysis diameter and subglottic diameter were optimal in 82.2% and 94.5% respectively. Time for the US measurements of radial epiphysis and subglottic area were 38.3±9.6 and 24.9±4.6 seconds respectively (p<0.001). The level of ease of US measurements were rated for radial epiphysis as 6 (5-9) and for subglottic area as 8 (7-9) (p<0.001). DISCUSSION AND CONCLUSION: US measured transverse diameter of distal radius epiphysis resulted in similar success rate to age-based formula in our child population. Subglottic diameter measured by US estimates ETT size more accurately; it is also less time consuming and easier.

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Section: Discussionmentioning

confidence: 99%

Estimation of Appropriate Endotracheal Tube Size in Pediatric Patients: Use of Epiphyseal Diameter of the Distal Radius and Subglottic Diameter

Altun¹,

Doruk²,

Dinçer³

et al. 2021

Jarss

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show abstract

“…Various techniques have been described to estimate tracheal tube size and depth of insertion at point-of-care. Ultrasound of the cricoid cartilage is also useful to estimate appropriate tracheal tube diameter [16]. The greatest utility of this technique will be in children who are significantly smaller or larger than children their age in whom standard equations to estimate size under- or over-estimate.…”

Section: Anatomymentioning

confidence: 99%

Pediatric airway management

Hsu

Ungern‐Sternberg

Engelhardt

2021

Current Opinion in Anaesthesiology

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Purpose of reviewChildren are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are therefore key to the practice of pediatric anesthesia. The goal of this review is to highlight recent publications (2019)(2020)(2021) aimed to advance pediatric airway safety and to highlight a proposed simple, pediatric-specific, universal framework to guide clinical practice. Recent findingsRecent investigations demonstrate that infants with normal and difficult airways experience high incidences of multiple laryngoscopy attempts and resulting hypoxemia. Video laryngoscopy may improve tracheal intubation first attempt success rate in infants with normal airways. In infants with difficult airways, standard blade video laryngoscopy is associated with higher first attempt success rates over non-standard blade video laryngoscopy. Recent studies in children with Pierre Robin sequence and mucopolysaccharidoses help guide airway equipment and technique selection. Department airway leads and hospital difficult airway services are necessary to disseminate knowledge, lead quality improvement initiatives, and promote evidence-based practice guidelines.

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“…Airway ultrasound has recently been identified as an accurate alternative to these formulas 6 . The ultrasound (US) assessment of the transverse cricoid diameter (TCD) has been demonstrated to accurately predict the OD of the ETT that best fits the pediatric airway preventing unnecessary tube exchanges with resultant airway edema 7,8 . The US‐measured epiphyseal diameter of the distal radius is another method that has been recently introduced as a surrogate for the tracheal diameter 9,10 .…”

Section: Introductionmentioning

confidence: 99%

“…6 The ultrasound (US) assessment of the transverse cricoid diameter (TCD) has been demonstrated to accurately predict the OD of the ETT that best fits the pediatric airway preventing unnecessary tube exchanges with resultant airway edema. 7,8 The US-measured epiphyseal diameter of the distal radius is another method that has been recently introduced as a surrogate for the tracheal diameter. 9,10 The issue is that the size of the airway can be considered a reflection of the body's growth, assuming that the growth rates of the cartilage all over the body are closely related to each other.…”

Section: Introductionmentioning

confidence: 99%

The accuracy of the ultrasound measured transverse cricoid diameter and the epiphyseal transverse diameter of the distal radius in predicting the pediatric endotracheal tube size

Abdel‐Ghaffar,

Thabet,

Abbas

et al. 2023

Pediatric Anesthesia

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BackgroundIn everyday pediatric anesthesia practice, clinicians frequently exchange an already inserted endotracheal tube because of a leak or resistance causing significant morbidity. We investigated the accuracy of two ultrasound measurements; the transverse cricoid diameter and epiphyseal diameter of the distal radius in the prediction of endotracheal tube size that best fits in children compared to age‐based formulas.PatientsOne hundred children (1–6 years) who underwent elective surgery with endotracheal tube whether cuffed (n = 50) or uncuffed (n = 50) were enrolled. The primary endpoint was the agreement between the reference tube size for which its outer diameter was selected based on transverse cricoid diameter and the final best‐fit‐ETT. The Correlation and Bland Altman agreement tests were conducted between best‐fit‐ETT outer diameter and ultrasound‐measured outer diameter, and between best‐fit‐ETT inner diameter and inner diameter calculated by age‐based formulas.ResultsThe agreement rate between transverse cricoid diameter‐based endotracheal tube size and best‐fit‐ETT size was 88% in cuffed group compared to 90% in uncuffed group. A significant positive correlation was reported between the outer diameter of best‐fit‐ETT and the outer diameter measured by the two ultrasound methods. A lower degree of positive correlation was reported between the inner diameter of best‐fit‐ETT, and the inner diameter calculated by age‐based formulas. Bland Altman's analysis showed agreement between best‐fit‐ETT outer diameter and epiphyseal diameter of the distal radius in both groups and with transverse cricoid diameter in the cuffed group, with no agreement with age‐based formulas in either group.ConclusionsBoth transverse cricoid diameter and epiphyseal diameter of the distal radius are reliable predictors of the size of best‐fit‐ETT pediatric endotracheal tube compared to age‐based formulas. To save time and effort, we recommend the US measurement of the epiphyseal diameter of distal radius in the preoperative visit and documenting the predicted tube size with the preoperative assessments.

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Accuracy of ultrasound to measure the cricoid cartilage diameter in children

Cited by 4 publications

References 13 publications

Estimation of Appropriate Endotracheal Tube Size in Pediatric Patients: Use of Epiphyseal Diameter of the Distal Radius and Subglottic Diameter

Estimation of Appropriate Endotracheal Tube Size in Pediatric Patients: Use of Epiphyseal Diameter of the Distal Radius and Subglottic Diameter

Pediatric airway management

The accuracy of the ultrasound measured transverse cricoid diameter and the epiphyseal transverse diameter of the distal radius in predicting the pediatric endotracheal tube size

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