Can ultrasound be useful for predicting the size of a left double-lumen bronchial tube? Tracheal width as measured by ultrasonography versus computed tomography

Šustić, Alan; Miletić, Damir; Protić, Alen; Ivančić, Aldo; Cicvarić, Tedi

doi:10.1016/j.jclinane.2007.11.002

Cited by 95 publications

(33 citation statements)

References 20 publications

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“…The ratio between left main-stem bronchus diameter on CT imaging and outer tracheal diameter measured with US was 0.68. These results were found to be comparable with those obtained using chest radiograph as a guide for selecting left double lumen tube size [52, 53]. In tracheostomised children, the size and shape of a potential replacement tracheostomy tube [54] can be determined by ultrasonographically measuring the tracheal width and the distance from the skin to the trachea.…”

Section: Resultssupporting

confidence: 54%

Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

et al. 2014

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ObjectivesTo create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians.MethodsThis is a narrative review combined with a structured Medline literature search.ResultsUltrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size.ConclusionsUltrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits.Teaching Points• Ultrasonography is becoming essential in management of the upper and lower airways.• The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation.• Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax.• Point-of-care ultrasonography of the airways has a steep learning curve.• Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.

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Section: Resultssupporting

confidence: 54%

Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

et al. 2014

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“…Imaging of the airway is a newer application of ultrasound. [91112] It can be used for prediction of paediatric ETT size,[13] prediction of double lumen tube size,[14] confirmation of correct placement of ETT,[12] diagnosis of upper airway pathology,[9] guidance of percutaneous tracheostomy[9] and cricothyroidotomy,[12] for performing nerve blocks to facilitate awake intubation,[15] in the detection of subglottic stenosis,[9] prediction of post-extubation stridor[16] and confirmation of proper laryngeal mask airway position. [9]…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography - A viable tool for airway assessment

2016

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Background and Aims:Accurate prediction of the Cormack-Lehane (CL) grade preoperatively can help in better airway management of the patient during induction of anaesthesia. Our aim was to determine the utility of ultrasonography in predicting CL grade.Methods:We studied 100 patients undergoing general endotracheal anaesthesia. Mallampati (MP) class, thyromental distance (TMD) and sternomental distance (SMD) were noted. Ultrasound measurements of the anterior neck soft tissue thickness at the level of the hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of the vocal cords (ANS-VC) and ratio of the depth of the pre-epiglottic space (Pre-E) to the distance from the epiglottis to the mid-point of the distance between the vocal cords (E-VC) were obtained. CL grade was noted during intubation. Chi-square test was employed to determine if there was any statistical difference in the measurements of patients with different CL grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for the various parameters.Results:The incidence of difficult intubation was 14%. An ANS-VC >0.23 cm had a sensitivity of 85.7% in predicting a CL Grade of 3 or 4, which was higher than that of MP class, TMD and SMD. However, the specificity, PPV and accuracy were lower than the physical parameters. The NPV was comparable.Conclusion:Ultrasound is a useful tool in airway assessment. ANS-VC >0.23 cm is a potential predictor of difficult intubation. ANS-Hyoid is not indicative of difficult intubation. The ratio Pre-E/E-VC has a low to moderate predictive value.

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“…The authors found a strong correlation between tracheal widths as measured by US and tracheal width and left main bronchus width as measured by computed tomography (CT). [13]…”

Section: Applications Of the Ultrasound In Airway Managementmentioning

confidence: 99%

“…Various clinical applications of US imaging of the upper airway include identification of endotracheal tube (ETT) placement,[5] guidance of percutaneous tracheostomy[67] and cricothyroidotomy,[8] detection of subglottic stenosis,[9] prediction of difficult intubation[10] and post-extubation stridor,[11] prediction of paediatric ETT[12] and double-lumen tube (DLT) size. [13] This article highlights briefly the review of various published data on the role of US in airway assessment and management.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound of the airway

Kundra¹,

Mishra²,

Ramesh³

2011

Indian J Anaesth

161

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Currently, the role of ultrasound (US) in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.

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Can ultrasound be useful for predicting the size of a left double-lumen bronchial tube? Tracheal width as measured by ultrasonography versus computed tomography

Cited by 95 publications

References 20 publications

Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

Ultrasonography - A viable tool for airway assessment

Ultrasound of the airway

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