Prediction of endotracheal tube size in the pediatric age group by ultrasound: A systematic review and meta-analysis

Gupta, Bhavna; Ahluwalia, Pallavi

doi:10.4103/joacp.joacp_650_20

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…16 A recent meta-analysis of 18 pediatric studies concluded that ultrasound is an effective and reproducible technique for predicting ETT size in children (r value .824, 95% CI 0.677-0.908). 17 In our experience, this modality is particularly helpful for patients with inaccurate conventional age-based methods, such as premature infants, children with subglottic stenosis, or children who are small for age.…”

Section: Selection Of Appropriate Endotracheal Tube Sizementioning

confidence: 99%

A Scoping Review of Ultrasonographic Techniques in the Evaluation of the Pediatric Airway

Burton

Bhargava

2023

J of Ultrasound Medicine

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Point of care ultrasound is making rapid advancements in pediatrics, and ultrasonographic assessment of the airway is being employed in many specialties such as the pediatric, cardiac, and neonatal intensive care units, emergency department, pulmonary clinic, and the perioperative setting. This scoping review provides a technical description of image acquisition and interpretation, accompanying ultrasound images of the hallmark airway applications in pediatrics, and supporting evidence when available. We describe and illustrate ultrasound‐determined endotracheal tube (ETT) sizing, ETT placement and depth confirmation, vocal fold assessment, prediction of post‐extubation stridor, difficult laryngoscopy prediction, and cricothyrotomy guidance. This review aims to provide the descriptions and images necessary to learn and apply these skills at the point of care in the pediatric patient.

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Section: Selection Of Appropriate Endotracheal Tube Sizementioning

confidence: 99%

A Scoping Review of Ultrasonographic Techniques in the Evaluation of the Pediatric Airway

Burton

Bhargava

2023

J of Ultrasound Medicine

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“…Using airway ultrasound, the subglottic diameter can be directly measured[ 59 ]. A recent meta-analysis showed that airway ultrasound can accurately predict tracheal tube size estimates, unlike the usual age or height-based formulas used in pediatric patients[ 60 ]. The minimal transverse diameter of the cricoid cartilage level was reported to be important to select the tracheal size for ventilation setting[ 61 ].…”

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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“…The pediatric patient group's tracheal structure is more specific [1][2][3]. Under eight years of age, unlike the adult larynx, the narrowest region of the larynx is the cricoid cartilage, and the cricoid has no flexibility (rima glottidis is the narrowest region in the adult) [1]. Accordingly, choosing the appropriate endotracheal tube (ETT) in pediatric patients is crucial.…”

Section: Introductionmentioning

confidence: 99%

“…Choosing the suitable and appropriate intubation tube is of great importance in preventing complications that may occur in the particular pediatric airway [2]. 1 2…”

Section: Introductionmentioning

confidence: 99%

The Effect of the Ultrasonography Measurement Method and the Conventional Measurement Method Used in Endotracheal Tube Size Selection in the Pediatric Patient Group on Postextubation Complications and Patient Recovery

Parpucu,

Şahin

2023

Cureus

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Introduction: In this study, we aimed to compare the cuffed intubation tube selected with the Cole formula and tracheal ultrasonography (USG) measurement method regarding postextubation complications in providing airway patency and determine its effects on patient recovery. Materials and method: Between 01 July 2022 and 30 June 2023, American Society of Anesthesiologists (ASA) risk group I-III, 4-6-year-old patients who underwent pediatric orthodontic surgery (multiple tooth extraction) were included in the study. Data of age, gender, weight, ASA risk group, history, Cole formula, USG measurement results used in the endotracheal tube (ETT) selection (one of the two whichever application was used), fasting time, intubation success, operation time, 30th-minute modified Aldrete recovery score (MASS), and postoperative complications due to intubation (within the first postoperative hour) were analyzed retrospectively. The patients were divided into two groups according to the method used by the anesthesiologists in selecting the ETT at the beginning of the operation. The group that used Cole formula management was named I, while the group that used the USG measurement method was called II. Intubation-related complication data of the patients in the first 1 hour postoperatively and MASS values at the 30th minute were compared between the groups. Results: In this study, 52.5% of the cases were male (n=42), 47.5% were female (n=38), the mean age was 4.84±0.84 years, and the mean body weight was 22.56±7.58 kilogram. There was no statistically significant difference between the groups regarding age, gender, body weight, ASA score, operation time, and period without oral consumption. ETT diameter measurement values according to groups were 4.73±0.46 mm in Group I and 4.41±0.61 mm in Group II. Postoperative 30th-minute MASS values were median 7 in Group I and median 8 in Group II (p<.001). MASS values were significantly higher in the Group II patient group. Intubation-related complications (postoperative cough, stridor, laryngospasm, tachypnea, wheezing, dysphonia) were observed in Group I with a rate of 40% within the first postoperative hour, while complications were marked with a rate of 17.5% in Group II (p=0.026). Complications in group II were significantly lower. Conclusion: In the pediatric age group, especially under the age of 6, trachea measurement with USG and ETT selection is an effective, safe, and noninvasive method compared to other conventional methods. ETT size selection with USG accelerates postoperative patient recovery and reduces the risk of intubation-related complications. In addition, inflating the tube cuff under USG guidance can prevent cuff-related complications.

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Prediction of endotracheal tube size in the pediatric age group by ultrasound: A systematic review and meta-analysis

Cited by 4 publications

References 31 publications

A Scoping Review of Ultrasonographic Techniques in the Evaluation of the Pediatric Airway

A Scoping Review of Ultrasonographic Techniques in the Evaluation of the Pediatric Airway

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

The Effect of the Ultrasonography Measurement Method and the Conventional Measurement Method Used in Endotracheal Tube Size Selection in the Pediatric Patient Group on Postextubation Complications and Patient Recovery

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