Comparative study on prediction of paediatric endotracheal tube size by ultrasonography and by age based formulas

Raphael, Paul O.; Thasim, Ershad; Simon, Binu Puthur; Rajagopal, Poongodi

doi:10.18203/2320-6012.ijrms20161889

Cited by 13 publications

(21 citation statements)

References 11 publications

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“…But due to airway size variations, these methods may not lead to appropriate tube size prediction. Ultrasound measurements are recently favored in endotracheal tube size selection for pediatric patients in children greater than one year old compared to age‐ and height‐based formulas. However, there is little known on the number of trials needed before gaining competence.…”

Section: Discussionmentioning

confidence: 99%

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Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients

Orhan-Sungur

Altun

Seyhan

et al. 2019

Pediatric Anesthesia

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Background: Endotracheal tube size can be predicted according to ultrasound measurement of subglottic airway diameter. The learning curve for this method is not yet established. The aim was to evaluate the learning curve of anesthesiology residents in ultrasound measurement of subglottic airway diameter for prediction of endotracheal tube size using cumulative sum analysis. Methods:Sixteen anesthesiology residents measured transverse subglottic airway diameter in children undergoing general anesthesia with cuffed endotracheal intubation. Each resident performed 30 ultrasound examinations. Primary outcome was the successful prediction of endotracheal tube size according to ultrasound measurement. Cumulative sum analysis was performed with acceptable and unacceptable failure rates set as 20 and 40%, respectively.Results: Ten out of 16 residents (62.5%) were deemed successful as they were able to pass lower decision boundary, whereas six residents' CUSUM scores were between the decisions lines deeming them indeterminate. The overall success rate for determining the correct endotracheal tube size was 77.5%. Median number of attempts to cross lower decision boundary was 29 with minimum of 18 and maximum of 29 attempts among successful residents. Conclusion:Learning curves constructed with cumulative sum analysis in this study showed that only 62.5% of residents were able to correctly predict cuffed endotracheal tube size with 80% success rate. Considerable variability in achieving competency necessitates objective follow-up of individual improvement. K E Y W O R D S endotracheal tube, learning curve, measurement, pediatric airway, ultrasound | 1195 ORHAN-SUNGUR et Al.when compared with magnetic resonance imaging in healthy adults and authors claimed that ultrasound was simple to learn despite operator dependency of the technique. However, this claim is not tested in pediatric patients with novice users. Therefore, in this prospective clinical trial-which is a part of assessment of pediatric airway and lung ultrasound learning-we aimed to evaluate the learning curve of anesthesiology residents in measurement of subglottic airway diameter for prediction of endotracheal tube size by cumulative sum (CUSUM) analysis. Our primary outcome was the successful prediction of endotracheal tube size by measuring transverse diameter of the subglottis. | MATERIAL S AND ME THODSApproval of Clinical Research Ethics Committee (2017/847) and written informed consent from anesthesiology residents and parents were obtained. Sixteen anesthesiology residents were included in the study to evaluate subglottic airway diameter in children aged between 1 and 8 years presented for adenoidectomy, tonsillectomy, or both who received general anesthesia with cuffed endotracheal intubation. Children with known tracheal and laryngeal pathologies, respiratory diseases, and anticipated difficult airway, as well as overweight or underweight children (body mass index above the 85th percentile or less than the 5th percentile, respectively), were excluded. A...

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Section: Discussionmentioning

confidence: 99%

“…Airway ultrasound can provide useful information for airway management including prediction of proper endotracheal tube size in pediatric patients as reported by several authors . Ultrasound owes its recent popularity in airway to its dynamic, real‐time, and minimally invasive assessment at bedside with user friendly features .…”

Section: Introductionmentioning

confidence: 91%

Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients

Orhan-Sungur

Altun

Seyhan

et al. 2019

Pediatric Anesthesia

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show abstract

“…Clinicians have used various formulas depending on demographic measurements such as age and height for pediatric endotracheal tube size selection, but these methods are not accurate and may produce conflicting results . Recently, ultrasound has been shown as a reliable, noninvasive method to evaluate the airway diameter, and several studies have investigated the role of ultrasound to guide ETT size selection in pediatric population (Table ). Our study differs from aforementioned studies, as we directly converted measured subglottic airway diameter to appropriate cuffed tube ID, rather than calculating a bulky formula and compared the best‐fit ID with age‐ and height‐based estimations.…”

Section: Discussionmentioning

confidence: 99%

The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients

Altun

Orhan-Sungur

Ali

et al. 2017

Pediatric Anesthesia

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“…They performed USG-guided estimation of tracheal diameter after induction of anesthesia during mask ventilation of patient. [ 9 ] In two studies, ETT size was estimated using the length-based method using Broselow tape that is used in pediatric resuscitation. However, validation of Broselow tape for ETT size estimation is done for children from the United States.…”

Section: Discussionmentioning

confidence: 99%

Is ultrasonography a better method of endotracheal tube size estimation in pediatric age group than the conventional physical indices-based formulae?

2020

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Comparative study on prediction of paediatric endotracheal tube size by ultrasonography and by age based formulas

Cited by 13 publications

References 11 publications

Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients

Learning curve of ultrasound measurement of subglottic diameter for endotracheal tube selection in pediatric patients

The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients

Is ultrasonography a better method of endotracheal tube size estimation in pediatric age group than the conventional physical indices-based formulae?

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