Prediction of endotracheal tube size using a printed three-dimensional airway model in pediatric patients with congenital heart disease: a prospective, single-center, single-group study

Abstract

Background: To determine the correct size of endotracheal tubes (ETT) for endotracheal intubation of pediatric patients, new methods have been investigated. Although the three-dimensional (3D) printing technology has been successful in the field of surgery, there are not many studies in the field of anesthesia. The purpose of this study is to evaluate the accuracy of a 3D airway model for prediction of the correct ETT size, and compare the results with a conventional age-based formula in pediatric patients.Methods: Thirty five pediatric patients under 6 years of age who were scheduled for congenital heart surgery. In the pre-anaesthetic period, the patient's computed tomography (CT) images were converted to STL (Standard Triangle Language) files using the 3D conversion program. An FDM (Fused Deposition Modelling) type 3D printer was used to print 3D airway models from the subglottis to the upper carina. ETT size was selected by inserting various sized cuffed-ETTs to a printed 3D airway model. Results:The 3D method selected the correct ETT size in 21 out of 35 pediatric patients (60%), whereas the age-based formula selected the correct ETT size in 9patients (26%).Conclusions: Prediction of correct size ETTs using a printed 3D airway model has demonstrated better results than the age-based formula. In particular, the selection of ETT size using a printed 3D airway model may be feasible for helping minimize re-intubation attempts and complications in the patients with congenital heart disease or an abnormal range of growth and development.

The Anesthetic Strategy for Patients with Mucopolysaccharidoses: A Retrospective Cohort Study

“…Therefore, discordant ETT size and difficult intubation should be separate concerns and implemented in respective strategies. Currently some advanced techniques such as ultrasound [ 24 , 25 ] and printed three-dimensional airway model [ 26 ] have been applied for measuring the diameter of pediatric trachea and predicting ETT size. Further investigation of these new techniques applied to MPS patients is necessary.…”

Length of the middle finger of hand as a simple and reliable predictor of optimal size of uncuffed endotracheal tube in paediatric patients: An observational study

“…Apart from the formulae considered for our study, there are many other predictors that have been proposed in the literature and we did not include them. [ 9 10 11 12 13 14 15 ] Nonetheless, we have included some of the most commonly used formulae for prediction of size of ETT in the paediatric population.…”

“…[ 9 10 11 12 ] Apart from ultrasonography, radiography and three-dimensional printer-based predictors have also been evaluated recently. [ 13 14 15 ] It will be interesting to compare them with these newly described predictive parameters. As the interest in cuffed ETTs has gained momentum, and the formulae for such tubes are different, comparison of middle finger length with such formulae would be interesting.…”

The Role of 3D Printing in Planning Complex Medical Procedures and Training of Medical Professionals—Cross-Sectional Multispecialty Review

“…Although the three-dimensional (3D) printing technology has been successful in the field of pre-operative planning in surgical interventions, there are not many studies in the field of anesthesia. One single-center study was conducted by Park et al and demonstrated better results of a printed 3D airway model (60%) in the prediction of the correct size of endotracheal tubes for endotracheal intubation than the age-based formula (26%) in pediatric patients with congenital heart disease [ 154 ]. There is also the potential of using a 3D model of a specific patient for preprocedural training and planning.…”