Use of ultrasonography as a noninvasive decisive tool to determine the accurate endotracheal tube size in anesthetized children

Göllü, Gülnur; Bermede, Onat; Khanmammadov, Farid; Ateş, Ufuk; Genç, Sinan; Can, Özlem Selvi; Fítöz, Suat; Alanoğlu, Zekeriyya; Yağmurlu, Aydın

doi:10.5546/aap.2018.eng.172

Cited by 6 publications

(12 citation statements)

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“…We systematically studied and evaluated the use of US for the assessment of ETT size in the pediatric age group Table 3 . [ 4 5 6 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] We wanted to examine whether the US measurements give us a reasonable enough idea of the size of the ETT to be inserted, whether there is any co-relation of US with the traditional formulas. Additional information was also gathered regarding the impact of the US learning curve, ease of insertion of the ETT, depth of insertion of the ETT, utility of the US to detect correct placement, any effect of the US on the ETT exchange rates, whether the real-time US reduced the need for repeated laryngoscopy and thus avoided airway trauma.…”

Section: Discussionmentioning

confidence: 99%

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

Gupta

Ahluwalia

2022

Journal of Anaesthesiology Clinical Pharmacology

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Anatomical differences in the airway in pediatric patients, compared to adults pose many challenges during endotracheal intubation, such as selecting the proper sized endotracheal tube (ETT) during intubation. Our primary objective was to assess how accurate is ultrasound (US) co-relation in comparison to standard age-based formulas in pediatric patients. Meta-analysis was registered in PROSPERO 2020, CRD42020220041. Online literature available in PubMed, Cochrane, and Embase, Goggle scholar was searched from year 2000 till November 30, 2020, using relevant Mesh terms, (‘airway US’ OR ((‘airway’/exp OR airway) AND (‘US’/exp OR US))) AND (‘endotracheal intubation’/exp OR ‘endotracheal intubation’) AND (‘pediatric’/exp OR pediatric)” to Predict endotracheal tube size/placement in pediatric age (neonate till 18 years) by the US. Bibliographic cross-references of selected publications were further manually screened. The full texts of each article were studied, once the abstract was found appropriate independently by two reviewers. A total of 48 papers published between 2010 and 2020 were identified as relevant and read in detail. Average numbers of patients were 86 and total numbers of patients were 1978. Most of the studies included pediatric patients posted for elective surgeries under general anesthesia and excluded emergency procedures, known laryngeal or tracheal pathology, high-risk patients, recent upper respiratory tract infections or allergy to ultrasound gel. A total of 18 independent correlations were analyzed. Final combined r value calculated from all the included articles was 0.824 (95% CI 0.677, 0.908) with a P < 0.00001 {strong co-relation ( r > 0.80)}. Q statistic of 756.484, and I 2 statistics of 97.53% showed a large degree of heterogeneity in the effect size across the studies. Use of US for upper airway in pediatric patients is an effective modality and can effectively predict endotracheal tube size estimations in comparison to standard age-based or height-based formulae in the pediatric age group. US is a non-invasive, cost-effective, portable, and reproducible technique as compared to CT and MRI. It also takes less time with increasing expertise and experience.

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Section: Discussionmentioning

confidence: 99%

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

Gupta

Ahluwalia

2022

Journal of Anaesthesiology Clinical Pharmacology

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography based predictors are gaining more attention, seem to be more accurate and it is possible that access to ultrasonography will increase in our country in the future. [ 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.…”

Section: Discussionmentioning

confidence: 99%

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

Saikia¹,

Thottan²

2021

Indian Journal of Anaesthesia

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Background and Aims: A recent study suggested middle finger length-based formula as a better predictive guide compared with age-based formula for selecting uncuffed endotracheal tubes (ETTs) in children. But that study did not meet sample size requirement. Thus, we primarily aimed to determine the accuracy of formula using length of the middle finger to determine the internal diameter of the uncuffed ETT and to compare its accuracy with the Cole's formula. As a secondary objective, we desired to compare its accuracy with some commonly used length and weight-based formulae. Methods: This prospective observational study included children aged up to 12 years posted for elective surgery under general anaesthesia. The length of the middle finger on the palmar aspect of the hand was measured in the preoperative period and the characteristics of the airway used were noted. A predefined criterion of optimal size of the uncuffed ETT was used. Results: A total of 139 patients were included in the final analysis. It was observed that the formula based on middle finger length can predict the optimal size of uncuffed ETT within an error of 0.5 mm in more than 90% instances and its predictive performance is better than Cole's formula. As a secondary outcome, we also observed that its accuracy is better than other formulae under evaluation. Conclusion: Formula based on middle finger length can be used as a predictor of optimal size of uncuffed ETT in paediatric patients and it is a better predictor than Cole's formula.

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“…Most of the studies included in this meta-analysis have evaluated the subglottic transverse diameter or the minimal transverse diameter of the subglottic airway (MTDSA)[ 4 5 ] but not the diameter at the cricoid level. The measured airway dimensions could also be altered by tracheal stretching in sniffing position[ 6 7 ] compared to a neutral position[ 4 8 ] and correlation with ultrasound-measured diameters may be affected for cuffed versus an uncuffed ETT. [ 9 ] The manual ventilation with positive pressure can also be anticipated to lead to tracheal dilation affecting the baseline measurement.…”

mentioning

confidence: 99%

“…[ 13 14 ] The formulas for determination of the size of the ETT required also differ among studies, using Cole’s age-based formula,[ 6 ] Penlington formula,[ 15 ] or the formulas proposed by Motoyama or Khine. [ 8 ]…”

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confidence: 99%

Ultrasound for prediction of endotracheal tube size in the pediatric age group: Are we there yet?

Bhatia

Paliwal

2022

Journal of Anaesthesiology Clinical Pharmacology

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Use of ultrasonography as a noninvasive decisive tool to determine the accurate endotracheal tube size in anesthetized children

Abstract: Ultrasonographical determination of transverse tracheal diameter is a suitable method for determining the correct endotracheal tube size when compared with the age based formulas.

Cited by 6 publications

References 0 publications

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

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

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

Ultrasound for prediction of endotracheal tube size in the pediatric age group: Are we there yet?

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