1
|
Taghizadeh Imani A, Goudarzi M, Shababi N, Nooralishahi B, Mohseni A. Comparison of four formulas for nasotracheal tube length estimation in pediatric patients: an observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:584-588. [PMID: 33932387 PMCID: PMC10533968 DOI: 10.1016/j.bjane.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/20/2021] [Accepted: 04/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Correct endotracheal intubation results in better ventilation, prevents hypoxia and its possible damages, such as brain injury, and minimizes attempts for re-intubation. Up to now, several formulas have been published to estimate nasotracheal intubation tube length. This study aims to compare the accuracy of different suggested formulas to find the one that better estimates the tube insertion distance. METHODS This cross-sectional retrospective study was carried out in 102 (51 female, 51 male) children who underwent cardiac surgery under general anesthesia. Inclusion criteria were correct nasotracheal intubation according to the postintubation chest X-ray (CXR). The estimated tracheal tube length was calculated by four different formulas. Pearson...s correlation coefficient was used to find the correlations between the estimated length of each formula and the correct nasotracheal tube length. Also, linear regression was used to obtain a formula to estimate nasotracheal tube length by weight, height, and age. RESULTS The formula L=3*tube size+2 had the best correlation with tube length (r ...=...0.81, Confidence Interval: 0.732...0.878, p-value < 0.001). Among demographic variables, height had the highest correlation coefficient with the tube length (r...=...0.83, Confidence Interval: 0.788...0.802, p-value < 0.001). Therefore, considering the height as an independent variable and tube length as a dependent variable, using linear regression, the following formula was achieved for determining tube length: nasotracheal tube length...=...0.1*Height+7. CONCLUSIONS The formula L=3*tube size+2 and the new suggested formula in this study can be used to estimate nasotracheal tube length in children under 4 years old. However, these formulas are only guides and require confirmation by auscultation and CXR.
Collapse
Affiliation(s)
- Ashkan Taghizadeh Imani
- Tehran University of Medical Sciences, Children...s Medical Center, Anaesthesiology Department, Tehran, Iran
| | - Mehrdad Goudarzi
- Tehran University of Medical Sciences, Children...s Medical Center, Anaesthesiology Department, Tehran, Iran
| | - Niloufar Shababi
- Tehran University of Medical Sciences, Children...s Medical Center, Anaesthesiology Department, Tehran, Iran.
| | - Behrang Nooralishahi
- Tehran University of Medical Sciences, Children...s Medical Center, Anaesthesiology Department, Tehran, Iran
| | - Alireza Mohseni
- Shahid Beheshti University of Medical Sciences, National Research Institute of Tuberculosis and Lung Diseases, Tracheal Diseases Research Center, Tehran, Iran
| |
Collapse
|
2
|
Burnhill G, Henshaw J, Lapitan S, Benson L, Lillie J. A Bedside Equation to Estimate Endotracheal Tube Length for Infants. J Pediatr 2023; 260:113476. [PMID: 37182663 DOI: 10.1016/j.jpeds.2023.113476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To develop a bedside equation that can be used to estimate the ideal oral and nasal endotracheal tube (ETT) length for children younger than 1 year of age. STUDY DESIGN Retrospective database analysis of 735 children younger than 1 year of age admitted to pediatric intensive care at Evelina London Children's Hospital from June 1, 2019, through August 31, 2021. ETT positions were determined by tube-tip superimposition over vertebral body on postintubation chest radiograph by trained medical students and pediatric radiologists with bedside assessment of ETT length at nostril or lip as recorded electronically by nursing staff. RESULTS The position of 1176 ETTs were evaluated, of which 784 (66%) were nasal and 392 (33%) were oral. After averaging length to account for multiple intubation events per patient, 281 (39%) nasal tubes and 105 (28%) oral tubes were found to be positioned optimally at T2. Using weight was superior to age or corrected age at estimating ETT length. Regression analysis revealed that optimal (T2) positioning of oral ETTs occurs at a length of (weight2+8) cm and in nasal ETTs at (weight2+9.5) cm with a mean absolute prediction error of 5%. The formulae did not require adjustments for those with comorbidities or prematurity. CONCLUSIONS The optimal insertion length of ETTs placed both orally and nasally in children up to 1 year of age can be estimated with appropriate accuracy by a simple bedside formula using weight as the only variable.
Collapse
Affiliation(s)
- Geoff Burnhill
- Paediatric Intensive Care Department, Evelina London Children's Hospital, London, United Kingdom
| | - Jack Henshaw
- King's College London University, London, United Kingdom
| | | | - Louis Benson
- King's College London University, London, United Kingdom
| | - Jon Lillie
- Paediatric Intensive Care Department, Evelina London Children's Hospital, London, United Kingdom; King's College London University, London, United Kingdom.
| |
Collapse
|
3
|
Chou CH, Tsai CL, Lin KL, Wu SC, Chiang MH, Huang HW, Hung KC. A new formula to predict the size and insertion depth of cuffed nasotracheal tube in children receiving dental surgery: a retrospective study. Sci Rep 2023; 13:12585. [PMID: 37537321 PMCID: PMC10400640 DOI: 10.1038/s41598-023-39793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023] Open
Abstract
This retrospective study aimed to develop a new formula for selecting the appropriate size and determining the depth of the cuffed nasotracheal intubation (NTI) for a cuffed endotracheal tube (cETT) in pediatric patients undergoing dental surgery. In addition, the clinical data on cETT (i.e., the size and depth of insertion) was compared with those calculated with age-based formulas to evaluate their correlation. A total number of 684 patients who received NTI were enrolled (healthy group, n = 607; special-need group, n = 77). The ETT size used in real-world scenarios was smaller (i.e., about 0.5 and 0.94 mm) than the age-based formula, while the ETT depth was greater (i.e., about 1.5 cm) than the age-based formula in both groups. In the healthy group, age, gender, and body weight were identified as predictors of ETT size and depth through multiple linear regression analysis, while only age and body weight were predictors in the special-needs group. New formulas were developed based on these findings, with ETT size = 3.98 + 0.052 × age + 0.048 × gender (male = 1, female = 0) + 0.023 × body weight (kg) and ETT depth = 15.1 + 0.43 × age + 0.300 × gender (male = 1, female = 0) + 0.007 × body weight (kg). The new formula could be useful for both healthy and special-need pediatric populations undergoing dental procedures.
Collapse
Affiliation(s)
- Chen-Hung Chou
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Ling Tsai
- Department of Pediatric Dentistry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kai-Lieh Lin
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Min-Hsien Chiang
- Department of Anesthesiology, Shin Huey Shin Hospital, Kaohsiung, Taiwan
| | - Hui-Wen Huang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, 804, Taiwan.
- Department of Anesthesiology, Chi Mei Medical Center, No. 901, ChungHwa Road, YungKung District, Tainan, 71004, Taiwan.
| |
Collapse
|
4
|
Ebenebe CU, Schriever K, Apostolidou S, Wolf M, Herrmann J, Singer D, Deindl P. Recommendations for endotracheal tube insertion depths in children. Emerg Med J 2023; 40:583-587. [PMID: 37336629 PMCID: PMC10423483 DOI: 10.1136/emermed-2022-212494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Endotracheal tube (ETT) malposition is frequent in paediatric intubation. The current recommendations for ETT insertion depths are based on formulae that hold various limitations. This study aimed to develop age-based, weight-based and height-based curve charts and tables for ETT insertion depth recommendations in children. METHODS In this retrospective single-centre study, we determined the individual optimal ETT insertion depths in paediatric patients by evaluating postintubation radiographic images. Age-based, weight-based and height-based ETT insertion depth recommendations were developed using regression analysis. We compared the insertion depths predicted by the models with previously published formulae. RESULTS Intubations of 167 children (0-17.9 years) were analysed. Best-fit curves generated with logistic regression analysis revealed R2 values between 0.784 and 0.880. The insertion depths predicted by the models corresponded well with published age-based and height-based formulae. However, they demonstrated the unsuitability of weight-related linear formulae to predict ETT depth in children. CONCLUSION The recommendations developed in this study facilitate a fast and accurate determination of recommended ETT insertion depths in children. Our recommendations provide greater accuracy than previously published formulae and demonstrate that weight-related linear formulae are unsuitable for predicting ETT depth in children.
Collapse
Affiliation(s)
| | - Kristina Schriever
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sofia Apostolidou
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Wolf
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Department of Interventional and Diagnostic Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Deindl
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
5
|
Kim HY, Kim EJ, Shin CS, Kim J. Shallow nasal RAE tube depth after head and neck surgery: association with preoperative and intraoperative factors. J Anesth 2019; 33:118-124. [PMID: 30603829 DOI: 10.1007/s00540-018-2595-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/30/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate risk factors associated with improper postoperative nasal Ring-Adair-Elwyn (RAE) tube depth. METHODS We retrospectively enrolled 133 adult patients who were admitted to the intensive care unit (ICU) with the nasal RAE tube after head and neck surgery. Postoperative chest radiography was performed to confirm nasal RAE tube depth immediately after the patient was admitted to the ICU. Proper tube depth was defined as the tube tip between 2 and 7 cm above the carina. The patients were divided into the proper-depth group (78 patients) and the improper-depth group (55 patients). Patients' characteristics were collected. The risk factors for improper postoperative tube depth were assessed using logistic regression analysis. MAIN RESULTS All patients who showed improper tube depth had a shallow tube depth (the tube tip > 7 cm above the carina). Multivariable analysis revealed that tall stature [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.08-1.25; P < 0.001], prolonged anesthesia duration (OR 1.16; 95% CI 1.02-1.32; P = 0.026), and right-sided surgical field as compared to the left (OR 0.36; 95% CI 0.14-0.93; P = 0.034) or median field (OR 0.25; 95% CI 0.07-0.85; P = 0.027) were risk factors associated with postoperative shallow tube depth. CONCLUSIONS Tall stature, prolonged anesthesia duration, and right-sided surgical field were independent risk factors for postoperative shallow nasal RAE tube depth.
Collapse
Affiliation(s)
- Ha Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Eung Jin Kim
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Cheung Soo Shin
- Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
6
|
Formelbasierte Berechnung der Tubusgröße für die präklinische Notfallmedizin. Notf Rett Med 2017. [DOI: 10.1007/s10049-016-0193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
Neunhoeffer F, Wahl T, Hofbeck M, Renk H, Esslinger M, Hanelt M, Kumpf M. A new method for determining the insertion depth of tracheal tubes in children: a pilot study. Br J Anaesth 2016; 116:393-7. [DOI: 10.1093/bja/aev545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
8
|
Abschätzung der optimalen Tubuslänge. Anaesthesist 2015; 65:115-21. [DOI: 10.1007/s00101-015-0123-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/27/2015] [Accepted: 11/28/2015] [Indexed: 11/26/2022]
|
9
|
Hunyady AI, Otto RK, Christensen A, Jonmarker C. Nares-to-carina distance in children: does a 'modified Morgan formula' give useful guidance during nasal intubation? Paediatr Anaesth 2015; 25:936-42. [PMID: 26033678 DOI: 10.1111/pan.12693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge of the normal nares-to-carina (NC) distance might prevent accidental bronchial intubation and be helpful when designing preformed endotracheal tubes (ETT). OBJECTIVE The aim was to measure NC distance and to examine whether a height/length-based 'modified Morgan formula' would give useful guidance for nasotracheal ETT depth positioning. METHODS Two groups were studied. A younger group consisted of nasally intubated postoperative patients. In these, NC distance was obtained as the sum of ETT length and the distance from the ETT tip to the carina, as measured from an anteroposterior chest X-ray. An older group consisted of children who had undergone computerized tomography (CT) examination including head, neck, and chest. In these, NC was measured directly from the CT image. The modified Morgan formula was derived from the NC vs height/length relationship. RESULTS Nares-to-carina distance was best predicted by a linear equation based on patient height. The equation in the younger group (1 day-8 years, n = 57) was: NC (cm) = 0.14 × height + 5.8, R(2) = 0.90, and in the older group (2.1-20 years, n = 45): NC (cm) = 0.15 × height + 3.4, R(2) = 0.93. The equation for the groups combined (n = 102) was: NC (cm) = 0.14 × height + 6.2, R(2) = 0.97. Based on the latter equation, a modified Morgan formula was identified as: ETT position at nares in cm = 0.12 × height + 5. If the ETT had been placed as calculated by this formula, the ETT tip would have been at 85 + 5% (mean ± sd) of NC distance, and the ETT tip-to-carina distance would have been 3.1 ± 1.1 cm (range 0-6.6). Bronchial intubation would not have occurred in any child, but a comparison to tracheal length measurements indicates that ETT tip position could be too proximal in some children. CONCLUSION The study confirms previous reports: NC distance can be well predicted from height/length. A modified Morgan formula might decrease the risk for accidental endobronchial intubation in infants and children, but ETT position need to be confirmed by auscultation or other verification.
Collapse
Affiliation(s)
- Agnes I Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Randolph K Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexis Christensen
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, WA, USA
| | - Christer Jonmarker
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
10
|
Kemper M, Dullenkopf A, Schmidt A, Gerber A, Weiss M. Nasotracheal intubation depth in paediatric patients. Br J Anaesth 2014; 113:840-6. [DOI: 10.1093/bja/aeu229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Kendirli T, Caltik A, Duman M, Yilmaz HL, Yildizdaş D, Boşnak M, Tekin D, Atay N. Effect of pediatric advanced life support course on pediatric residents' intubation success. Pediatr Int 2011; 53:94-9. [PMID: 20337984 DOI: 10.1111/j.1442-200x.2010.03128.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Pediatric Advanced Life Support Program (PALS) course very important for teaching about intubation, resuscitation, shock, trauma, respiratory failure and rhythm disturbances. The aim of the present study was to evaluate the effect of the PALS course on pediatric residents' intubation success during their rotation, daytime and night-time practice in the pediatric intensive care unit (PICU). METHODS The study was carried out from 1 March 2005 to 28 February 2007. The study period had two parts, in that the number of attempts and successful intubations performed by pediatric residents, and the pediatric intensivist successful intubation ratio were evaluated in two different periods: before the PALS course, 1 March 2005-28 February 2006, and after the PALS course, 5 March 2006-28 February 2007. The participating residents' pediatric levels (PL) were classed as PL-1, PL-2, PL-3, PL-4, and all had first experience in the PICU at the PL-1 level. The PALS instructor was a pediatric emergency or intensive care doctor. We evaluated whether the PALS course influenced intubation success or not. RESULTS Sixteen residents participated in the study. The proportion of successful intubations was 110 (53.3%) and 104 (65.4%) attempts before and after the PALS course, respectively. The proportion of intubations done by intensivists decreased from 49.1% to 31.7% before and after PALS. The most frequently used endotracheal tube (ETT) internal diameter (ID) was 4.0 mm, and cuffed ETT was used 16% and 21% before and after the course, respectively. Appropriate placing of ETT tip occurred 70.4% and 82.2% of the time before and after the PALS course, respectively. Proportion of successful intubations by residents increased in all levels, except for PL-1. The most important reason for unsuccessful attempts was inappropriate patient position. Only one patient could not be intubated, and laryngeal mask airway was used in that case. During intubation, complications were broken teeth in two patients before the course, and subglottic stenosis developed in only one patient due to cuffed ETT. CONCLUSION Successful intubation is a life-saving intervention during resuscitation, ETT revision for extubation or obstruction for extubation or obstruction during mechanical ventilation. This skill can be developed in the PALS course and by clinical study in PICU and pediatric emergency services. The PALS course must be given to pediatric residents especially within the first year. Also, cuffed ETT can be used for infants and children.
Collapse
Affiliation(s)
- Tanil Kendirli
- Ankara University School of Medicine, Pediatric Intensive Care Unit, Dikimevi, 06100, Ankara, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
BACKGROUND The aim of this study was to determine the accuracy of standard techniques for estimating oral and nasal tracheal tube length in children and to devise more accurate predictive formulae that can be used at the bedside. METHODS Data were collected from 255 children who required tracheal intubation whilst on the Pediatric Intensive Care Unit over a period of 1 year. Age, weight, the final length of the tracheal tube and the internal diameter were documented. Patients with a tracheostomy were excluded from the study. RESULTS Using linear regression the following formulae best predicted final tracheal tube length. For children over 1 year of age: Insertion depth (cm) for orotracheal intubation = age/2 + 13 Insertion depth (cm) for nasotracheal intubation = age/2 + 15 For children below 1 year of age: Insertion depth of orotracheal tube (cm) = weight/2 + 8 Insertion depth of nasotracheal tube (cm) = weight/2 + 9 CONCLUSIONS Current Advanced Paediatric Life Support guidelines underestimate the appropriate tracheal tube lengths for orotracheal intubation in children over 1 year of age. Similarly, the novel weight-based formulae for tracheal tube lengths in children below the age of 1 year proved more accurate than standard reference charts. We therefore recommend that these new formulae are prospectively evaluated.
Collapse
Affiliation(s)
- Nicky Lau
- University of Manchester Medical School, Manchester, UK
| | | | | | | |
Collapse
|
13
|
|