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

Abstract

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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Prediction of endotracheal tube size in pediatric patients: Development and validation of machine learning models

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