Pediatric tracheal dimensions on computed tomography and its correlation with tracheostomy tube sizes

Naina, P.; Syed, Kamran Asif; Irodi, Aparna; John, Mary; Varghese, Ajoy Mathew

doi:10.1002/lary.28141

Cited by 11 publications

(7 citation statements)

References 37 publications

(53 reference statements)

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“…The following factors were examined to determine their influence on the ability of an endotracheal cuff to maintain a seal within an airway: cuff diameter, duration of time required for endotracheal intubation, timing of intubation, duration of sedation, number of times the patient was repositioned, number of times suctioning was performed, 15 head position 16 sex, 17 age, 18 and weight and height. 19 Instrument and equipment: AVEA ventilator systems (Vyaire Medical, Mettawa, IL, USA) were used in this study. The mode of mechanical ventilation was determined by the physician.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH2O during mechanical ventilation: A cross-sectional study

Wu¹,

H²,

Shi³

et al. 2023

Pak J Med Sci

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Objectives: The cuff pressures > 30 cmH2O may create a seal in the trachea. The objective of this study was to identify risk factors associated with lack of tracheal sealing by an endotracheal cuff inflated to > 30 cmH2O in patients undergoing mechanical ventilation. Methods: This prospective cross-sectional study was conducted from 2019 to 2020 in the cardiothoracic intensive care unit and respiratory medical care unit of a Hospital in Nantong, China. Patients aged >16 years undergoing cardiothoracic surgery with mechanical ventilation using endotracheal intubation were included. Patient characteristics and ventilator parameters were analyzed. Cuff pressure was maintained with the minimum leak technique (MLT) and measured with a cuff pressure gauge. Cuff pressure was measured for 30 seconds when ventilation was accompanied by no leak, simultaneously detected by the ventilator or auscultation with a stethoscope. Results: Of 352 patients undergoing mechanical ventilation, 51 patients (14.5%) had a cuff pressure of >30 cmH2O. Multivariable analysis showed that cuff manufacturer (Guangzhou Weili) and nasal endotracheal intubation significantly increased the risk of an unsealed trachea. Peak inspiratory pressure, cuff diameter and male sex had a strong inverse association with an unsealed trachea. Conclusions: These findings suggest that an endotracheal cuff pressure of 20 to 30 cmH2O is adequate for most patients, but lack of a tracheal seal still occurs in a small number of people. An unsealed trachea is most likely because cuff and tracheal diameters do not match. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx Unique identifier: ChiCTR-COC-15006459. doi: https://doi.org/10.12669/pjms.39.2.5672 How to cite this: Wu H, Shi H, Shi J, Shen W. Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH2O during mechanical ventilation: A cross-sectional study. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.5672 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Methodsmentioning

confidence: 99%

Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH2O during mechanical ventilation: A cross-sectional study

Wu¹,

H²,

Shi³

et al. 2023

Pak J Med Sci

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“…The size of cuffed endotracheal tubes in children is determined using Motoyama's formula (3.5 + patient age/4) [36]. This formula may assist in approximate tracheostomy tube sizing in children although patient factors can affect the formula's accuracy [37]. For this reason, many surgeons advocate for full airway endoscopy prior to the initial skin tracheostomy incision.…”

Section: Tracheostomy Sizingmentioning

confidence: 99%

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

Fuller

Wineland

Richter

2021

Curr Otorhinolaryngol Rep

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Purpose of Review Tracheostomy in a child demands critical pre-operative evaluation, deliberate family education, competent surgical technique, and multidisciplinary post-operative care. The goals of pediatric tracheostomy are to establish a safe airway, optimize ventilation, and expedite discharge. Herein we provide an update regarding timing, surgical technique, complications, and decannulation, focusing on a longitudinal approach to pediatric tracheostomy care. Recent Findings Pediatric tracheostomy is performed in approximately 0.2% of inpatient stays among tertiary pediatric hospitals. Mortality in children with tracheostomies ranges from 10–20% due to significant comorbidities in this population. Tracheostomy-specific mortality and complications are now rare. Recent global initiatives have aimed to optimize decision-making, lower surgical costs, reduce the length of intensive care, and eliminate perioperative wound complications. The safest road to tracheostomy decannulation in children remains to be both patient and provider dependent. Summary Recent literature provides guidance on safe, uncomplicated, and long-term tracheostomy care in children. Further research is needed to help standardize decannulation protocols.

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“…Currently, there are several methods for prediction of ETT size, of which traditional predictive formulas are the most widely used in view of safety and convenience, but these formulas are not accurate and may produce conflicting results ( 8 , 17 , 26 ). In this multicenter retrospective study, we developed and validated machine learning models, which could be used to predict the optimal ETT size in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Xu²,

Xu³

et al. 2022

Front. Pediatr.

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ObjectiveWe aimed to construct and validate machine learning models for endotracheal tube (ETT) size prediction in pediatric patients.MethodsData of 990 pediatric patients underwent endotracheal intubation were retrospectively collected between November 2019 and October 2021, and separated into cuffed and uncuffed endotracheal tube subgroups. Six machine learning algorithms, including support vector regression (SVR), logistic regression (LR), random forest (RF), gradient boosting tree (GBR), decision tree (DTR) and extreme gradient boosting tree (XGBR), were selected to construct and validate models using ten-fold cross validation in training set. The optimal models were selected, and the performance were compared with traditional predictive formulas and clinicians. Furthermore, additional data of 71 pediatric patients were collected to perform external validation.ResultsThe optimal 7 uncuffed and 5 cuffed variables were screened out by feature selecting. The RF models had the best performance with minimizing prediction error for both uncuffed ETT size (MAE = 0.275 mm and RMSE = 0.349 mm) and cuffed ETT size (MAE = 0.243 mm and RMSE = 0.310 mm). The RF models were also superior in predicting power than formulas in both uncuffed and cuffed ETT size prediction. In addition, the RF models performed slightly better than senior clinicians, while they significantly outperformed junior clinicians. Based on SVR models, we proposed 3 novel linear formulas for uncuffed and cuffed ETT size respectively.ConclusionWe have developed machine learning models with excellent performance in predicting optimal ETT size in both cuffed and uncuffed endotracheal intubation in pediatric patients, which provides powerful decision support for clinicians to select proper ETT size. Novel formulas proposed based on machine learning models also have relatively better predictive performance. These models and formulas can serve as important clinical references for clinicians, especially for performers with rare experience or in remote areas.

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Pediatric tracheal dimensions on computed tomography and its correlation with tracheostomy tube sizes

Cited by 11 publications

References 37 publications

Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH2O during mechanical ventilation: A cross-sectional study

Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH2O during mechanical ventilation: A cross-sectional study

Update on Pediatric Tracheostomy: Indications, Technique, Education, and Decannulation

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

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