Choice of the correct size of endotracheal tube in pediatric patients

Park, Seyeon; Shin, Sang‐Wook; Kim, Hye-Jin; Byeon, Gyeong-Jo; Yoon, Ji-Uk; Kim, Eun-Jung; Kim, Hee Young

doi:10.17085/apm.22215

Cited by 10 publications

(5 citation statements)

References 47 publications

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“…Therefore, it is important to consider the effects of patient height and tracheal length when selecting the ETT insertion technique. Ultimately, research is needed to further understand the risks associated with different ETT insertion methods 20 .…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Auscultation During General Anesthesia by Taking Fiberoptic Bronchoscopy as Gold Standard

Hussain¹,

Asad²,

Fayyaz³

et al. 2023

PJMHS

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Objective: To evaluate the diagnostic accuracy of auscultation in the detection of inappropriate positioning of endotracheal tube, in patients undergoing elective surgeries, by taking fiberoptic bronchoscopy as gold standard. Study design: cross sectional study Place and duration: Department of anesthesia, Nishtar Hospital, Multan Methodology: A total of 205 patients admitted in general surgery ward were included in the study. The pre-operative assessment was done one day before surgery. The level of difficulty of intubation was assessed during pre-operative assessment. SPSS version 23 was used for data analysis. Tests of significance chi square and t-test were applied. P-value < 0.05 was taken as statistically significant. Results: Therefore, the estimated sensitivity was 72.03%. The estimated specificity was 65.6%. Positive predictive value was 73.9% and negative predictive value was 63.3%. Two hundred and five patients were included in this study of both genders. Gender distribution revealed as n=144 (70.2%) males and n=61 (29.8%) females. The mean age of the patients was 38.92±10.61years. ASA status I and II observed as n=121 (59.0%) and n=84 (41.0%), respectively. Mallampati grading I and II observed as n=127 (62.0%) and n=78 (38.0%), respectively. Laryngoscopy grading I and II observed as n=135 (65.9%) and n=70 (34.1%), respectively. Practical Implication: The main objective of this study was to evaluate the relative diagnostic accuracy of auscultation during GA. Therefore, we evaluated each technique's sensitivity, specificity, (PPV), (NPV) and overall accuracy in detecting incorrect endotracheal tube positioning. Conclusion: The five point auscultation technique is a reliable method of confirmation of endotracheal intubation, as verified by flexible fiberoptic bronchoscope. Keywords: Auscultation, Fiberoptic bronchoscopy, General analgesia, Diagnostic accuracy, sensitivity.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Auscultation During General Anesthesia by Taking Fiberoptic Bronchoscopy as Gold Standard

Hussain¹,

Asad²,

Fayyaz³

et al. 2023

PJMHS

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“…However, 8.0 mm ID ETTs can often be seen in the intensive care unit as disease and ventilatory requirements may necessitate a larger caliber tube 17,18 . Smaller ETTs may result in inadequate ventilation, air leakage, higher risk of aspiration, and an inability to adequately suction or pass a fiberscope without interrupting ventilation 19 . However, our findings support that even a seemingly minor change from an 8.0 mm ID ETT to a 7.5 ETT may mean a large reduction in resultant laryngotracheal pressures and should be considered when feasible.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal tube forces exerted on the larynx and a novel support device to reduce it

Vahabzadeh‐Hagh,

Marsh‐Armstrong,

Patel

et al. 2023

Laryngoscope Investig Oto

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ObjectiveEndotracheal tubes (ETTs) are commonly associated with laryngeal injury that may be short lasting and temporary or more severe and life altering. Injury is believed to result from forces that these ETTs exert on the larynx. Here we quantify the forces of ETTs of various sizes on the laryngotracheal complex to gain a more quantitative understanding of these potential damaging forces. Here we also perform preclinical testing of a novel support device to offload these forces.MethodsEndotracheal intubation was performed on a fresh human cadaver using various ETT sizes. A strain‐sensitive graphene nanosheet sensor and a commercially available force sensing resistor were secured behind the larynx, anterior to the prevertebral fascia. The forces exerted on the larynx were measured for each of the commonly used ETTs. A novel support device, ETT clip (Endo Clip), was attached to the ETTs and changes in these forces were observed.ResultsForces exerted on the laryngotracheal complex by various ETTs were observed to increase with increasing tube size. This pressure can be significantly reduced with a novel ETT clip.ConclusionHere we demonstrate the first quantitative measurement of forces that ETTs exert on the larynx. We demonstrate a novel device that can easily clip onto an ETT reducing pressure on the laryngotracheal complex. This preclinical test paves the way for a human clinical trial.Level of evidence5.

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“…The minimal transverse diameter of the cricoid cartilage level was reported to be important to select the tracheal size for ventilation setting[ 61 ]. The ultrasound measurement points for determining tube size vary slightly among investigators, which include the narrowest part of the subglottic airway, the middle or most caudal part of the cricoid cartilage, and so on[ 62 ]. Although the usefulness of ultrasound in selecting tube size in pediatric tracheal intubation is unquestioned, further research is needed to standardize this approach.…”

Section: Can Airway Ultrasound Be Used To Predict Tracheal Tube Size?mentioning

confidence: 99%

Airway ultrasound for patients anticipated to have a difficult airway: Perspective for personalized medicine

Nakazawa¹,

Uzawa²,

Tokumine³

et al. 2023

World J Clin Cases

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Airway ultrasound allows for precise airway evaluation, particularly for assessing the difficult airway and the potential for front of neck access. Many studies have shown that identification of the cricothyroid membrane by airway ultrasound is more accurate than digital palpation. However, no reports to date have provided clinical evidence that ultrasound identification of the cricothyroid membrane increases the success rate of cricothyroidotomy. This is a narrative review which describes patients with difficult airways for whom airway ultrasound may have been useful for clinical decision making. The role of airway ultrasound for the evaluation of difficult airways is summarized and an approach to the use of ultrasound for airway management is proposed. The goal of this review is to present practical applications of airway ultrasound for patients predicted to have a difficult airway and who undergo cricothyroidotomy.

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Choice of the correct size of endotracheal tube in pediatric patients

Cited by 10 publications

References 47 publications

Diagnostic Accuracy of Auscultation During General Anesthesia by Taking Fiberoptic Bronchoscopy as Gold Standard

Diagnostic Accuracy of Auscultation During General Anesthesia by Taking Fiberoptic Bronchoscopy as Gold Standard

Endotracheal tube forces exerted on the larynx and a novel support device to reduce it

Airway ultrasound for patients anticipated to have a difficult airway: Perspective for personalized medicine

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