Ultrasonographic Measurement of Subglottic Diameter for Paediatric Cuffed Endotracheal Tube Size Selection: Feasibility Report

Abstract

Amaç: Bu fizibiliti çalışmasının amacı pediyatrik hastalarda uygun büyüklükte kaflı endotrakeal tüpün (ETT) öngörülmesinde ultrasonografinin (USG) ilk girişim başarısını araştırmaktır.Yöntemler: Çalışmaya 1-10 yaş arası adenoidektomi veya adenotonsillektomi için endotrakeal entübasyon ile genel anestezi alan 50 çocuk dahil edilmiştir. Bütün katılımcılarda subglottik havayolunun transvers çapı krikoid kartilaj seviyesinden ventilasyon yapılmadan ultrasonografi ile ölçülmüştür. izin verilen maksimum ETT dış çapı (DÇ) ölçülen sublottik havayolu çapına göre seçilmiştir. Tüpün trakeadan geçişi sırasında dirençle karşılaşılması halinde veya havayolu basıncı >25 cm H 2 O'da duyulabilen kaçak varlığında ETT iç çapı (iÇ) 0,5 mm olan bir başkasıyla değişti-rilmiştir. Eğer havayolu basıncı <10 cm H 2 O'da duyulabilen kaçak varsa veya kaf basıncı >25 cm H 2 O'ya ulaşmıyorsa veya tepe havayolu basıncı ventilasyon sırasında >25 cm H 2 O ise tüp bir büyük çapla değiştirilmiştir. En iyi uyan ETT DÇ'ı iÇ'a dönüştü-rülmüştür. En uygun iÇ, ETT değiştirme ihtiyacı, ultrasonografi ile havayolu çapı ölçüm süresi, ve tepe havayolu basınçları kaydedilmiştir. Bulgular:Ultrosonografi ile ilk deneme başarı oranı %86, ETT 5 hastada bir numara büyük olan, 2 hastada bir numara küçükle değiştirilmiştir.Sonuç: Bulgularımız USG ile ölçülen subglottic çapın uygun pediyatrik ETT çapının belirlenmesinde daha güvenilir bir belirleyici olduğunu göstermiştir. Anahtar kelimeler: Pediatrik endotrakeal tüp, subglottik çap, ultrasonografiObjective: The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. Methods:Fifty children who were 1-10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H 2 O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm H 2 O, if a seal could not be achieved with a cuff pressure of >25 cm H 2 O or if a peak airway pressure of >25 cm H 2 O was observed during ventilation, the tube was changed to a tube one size larger. The OD of the best-fit ETT was converted to the ID. The best-fit ID, the requirement for ETT replacement, the duration of airway diameter measurement by USG and the peak airway pressure were recorded. Results:The success rate of the first attempt with USG was 86%; the ETT was replaced in five patients with a tube one size larger and in two patients with a tube one size smaller. Conclusion:Our findings show the subglottic di...

Prediction of endotracheal tube size in children by predicting subglottic diameter using ultrasonographic measurement versus traditional formulas

“…Readily available ultrasound devices and increasing familiarity of anaesthesiologists has made a way for consideration of this modality in the assessement of paediatric airway. [ 9 10 ]…”

Routine use of ultrasonography in prediction of uncuffed endotracheal tube size in pediatric patients

“…In our study, we studied US use in pediatric intubation using uncuffed ETT in children aged 2-10 years with the exclusion of infants and younger children less than 2 years as they may have additional age-related anatomical intubation difficulties. Altun et al (Altun et al 2016;Altun et al 2017) studied children of the same age group (1-10 years); however, they used cuffed rather than uncuffed tubes. Schramm et al (Schramm et al 2012) had studied uncuffed ETT; however, they studied younger age groups (less than 5 years).…”

“…We have studied patients undergoing surgeries away from head and neck (Table 2) to exclude the possibility of additional airway difficulty and shared the origin of post-intubation complications (if any). While Altun et al (Altun et al 2016;Altun et al 2017) had studied pediatric patients undergoing adenotonsillectomy, Schramm et al (Schramm et al 2012) studied children undergoing multiple types of surgery including ENT surgeries with shared airway.…”

“…The optimal uncuffed ETT size is that which has no audible leakage below a ventilation pressure of 10 cmH 2 O and with an audible leakage above 20 cmH 2 O (Shibasaki et al 2010). We changed the ETT to 0.5 mm smaller size if there was no leak at pressure 20 CmH 2 O and to 0.5 mm larger size if still there was a leak below pressure 10 cmH 2 O (Altun et al 2016;Altun et al 2017).…”

Comparison of the Effectiveness of Tracheal Ultrasonography and Conventional Techniques for the Determination of Endotracheal Tube Diameter in Pediatric Patients Undergoing Cardiac Surgeries

“…Son yıllarda ultrasonografi (USG)'nin günlük pratiğe girmesiyle pediatrik hava yollarının subglottik transvers çapının ölçümü ile ETT çapının klasik formüllere nazaran daha güvenilir tespit edildiğine dair çalışmalar bildirilmiştir (4)(5)(6) .…”