Comparisons of recursive partitioning analysis and conventional methods for selection of uncuffed endotracheal tubes for pediatric patients

Cho, Ah Reum; Kim, Eun Soo; Lee, Do Won; Hong, Jung Min; Kwon, Jae Young; Kim, Hae Kyu; Kim, Tae Kyun

doi:10.1111/pan.12620

Cited by 9 publications

(16 citation statements)

References 22 publications

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“…The main findings of this study were that (1) appropriately sized ETTs were present in 77% of patients, (2) air leakage was absent at the pressure of 30 cmH 2 O after ETT replacement in 52% of patients, and (3) leak rate rather than P Leak was associated with the presence of air leakage after ETT replacement. Although there have been many studies [18][19][20][21][22][23] on the size of uncuffed ETTs that determined the appropriate size based on P Leak , most of these studies did not report the data on the inappropriately sized ETTs; this was done only by Park et al [22] They investigated uncuffed ETT size among 605 patients between 3 and 6 years of age. After excluding patients based on their exclusion criteria, such as air P Leaks of < 10 or > 30 cmH 2 O, they finally analyzed the data of 537 patients.…”

Section: Discussionmentioning

confidence: 99%

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Frequency of the requirement of inappropriate uncuffed tracheal tube size for pediatric patients: a retrospective observational analysis

2021

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Background The insertion of inappropriately sized uncuffed endotracheal tubes (ETTs) with a tight seal or presence of air leakage may be necessary in children. This study aimed to analyze the frequency of the requirement of inappropriately sized uncuffed ETT insertion, air leakage after the ETT was replaced with one of a larger size, and factors associated with air leakage after ETT replacement. Methods Patients under 2 years of age who underwent oral surgery under general anesthesia with uncuffed ETTs between December 2013 and May 2015 were enrolled. The ETT size was selected at the discretion of the attending anesthesiologists. A leak test was performed after intubation. The ETT was replaced when considered necessary. Data regarding the leak pressure (PLeak) and inspiratory and expiratory tidal volumes were extracted from anesthesia records. We considered a PLeak of 10 < PLeak ≤ 30 cmH2O to be appropriate. The frequencies of the requirement of inappropriately sized ETTs, absence of leakage after ETT replacement, ETT size difference, and leak rate were calculated. A logistic regression was performed, with PLeak, leak rate, and size difference included as explanatory variables and presence of leakage after replacement as the outcome variable. Results Out of the 156 patients enrolled, 109 underwent ETT replacement, with the requirement of inappropriately sized ETTs being observed in 25 patients (23%). ETT replacement was performed in patients with PLeak ≤ 10 cmH2O; leakage was absent after replacement (PLeak < 30 cmH2O) in 52% of patients (25/48). In the multivariate logistic model, the leak rate before ETT replacement was significantly associated with the presence of leakage after replacement (p = 0.021). Conclusions Inappropriately sized ETTs were inserted in approximately 23% of the patients. The leak rate may be useful to guide ETT replacement.

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Section: Discussionmentioning

confidence: 99%

“…Further, a mean variance of 38% was observed in the mean P Leak measured by two observers [12]. However, the appropriate size of the uncuffed ETT was still determined based on P Leak in most of these studies [18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Frequency of the requirement of inappropriate uncuffed tracheal tube size for pediatric patients: a retrospective observational analysis

2021

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“…In some studies, the standard ABF has correctly predicted the size of TT in a high proportion of children (60%-86%) of variable ages from Asia,[48] as well as the US. [2021] There are other studies from Asia,[911] and Europe,[1222] where the accuracy of ABF was low (24%-47%).…”

Section: Discussionmentioning

confidence: 99%

“…Multivariate formulae are usually more accurate but require complex calculations and hence are difficult to use in day-to-day practice. [9] Ultrasound also determines the tracheal size accurately, but is not universally available, specially outside the operation theatre, and predicts the outer and not the inner diameter of the TT. [8]…”

Section: Introductionmentioning

confidence: 99%

Derivation and validation of a formula for paediatric tracheal tube size using bootstrap resampling procedure

et al. 2019

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Background and Aims: The accuracy of age-, length- and weight-based formulae to predict optimal size of uncuffed tracheal tubes (TTs) in children varies widely. We determined the accuracy of age, length and weight in predicting the size of TT in Indian children, and derived and validated a formula using the best predictor. Methods: In the derivation phase, 100 children aged 1-8 years undergoing general anaesthesia and tracheal intubation with an uncuffed tube were prospectively studied. The correct size of the TT used was confirmed using the leak test. A bootstrap resampling procedure was used to estimate the accuracy of the predictors (age, weight, or length alone; length and age; length and weight; and length, weight and age). The best predictor was used to derive a formula (Paediatric Tube Size Predictor, PTSP) to calculate the size of TT. The accuracy of PTSP was tested in 150 children of the same age group in the validation phase. Results: Length (L (in meters), R 2 = 0.61) was the best single predictor of the size of TT and was used to derive the PTSP as internal diameter = 3L + 2.5. In the validation phase, the PTSP predicted the size of TT correctly in 75% of children. Re-intubation was associated with a higher incidence of respiratory morbidity than one-time tracheal intubation. Conclusion: Length of the child predicts the size of an uncuffed TT better than age and weight. The PTSP formula based on length correctly predicts the size of uncuffed TT in 75% of children.

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“…This flowchart is simple, visually attractive with a correct predictability rate of 59.5%, and a close prediction rate of 93.7%. [ 21 ]…”

Section: Discussionmentioning

confidence: 99%

Predicting endotracheal tube size from length: Evaluation of the Broselow tape in Indian children

Subramanian

Nishtala

Ramavakoda

et al. 2018

J Anaesthesiol Clin Pharmacol

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Comparisons of recursive partitioning analysis and conventional methods for selection of uncuffed endotracheal tubes for pediatric patients

Cited by 9 publications

References 22 publications

Frequency of the requirement of inappropriate uncuffed tracheal tube size for pediatric patients: a retrospective observational analysis

Frequency of the requirement of inappropriate uncuffed tracheal tube size for pediatric patients: a retrospective observational analysis

Derivation and validation of a formula for paediatric tracheal tube size using bootstrap resampling procedure

Predicting endotracheal tube size from length: Evaluation of the Broselow tape in Indian children

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