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Zhuang PE, Lu JH, Wang WK, Cheng MH. A new formula based on height for determining endotracheal intubation depth in pediatrics: A prospective study. J Clin Anesth 2023; 86:111079. [PMID: 36796213 DOI: 10.1016/j.jclinane.2023.111079] [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: 10/17/2022] [Revised: 01/04/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
STUDY OBJECTIVE The main objective was to devise an endotracheal intubation formula based on pediatric patients' strongly correlated growth parameters. The secondary objective was to compare the accuracy of the new formula to the age-based formula from Advanced Pediatric Life Support Course (APLS formula) and the middle finger length-based formula (MFL-based formula). DESIGN A prospective, observational study. SETTING Operation. PATIENTS 111 subjects age 4-12 years old undergoing elective surgeries with general orotracheal anesthesia. INTERVENTIONS AND MEASUREMENTS Growth parameters, including age, gender, height, weight, BMI, middle finger length, nasal-tragus length, and sternum length, were measured before surgeries. Tracheal length and the optimal endotracheal intubation depth (D) were measured and calculated by Disposcope. Regression analysis were used to establish a new formula for predicting the intubation depth. A self-controlled paired design was used to compare the accuracy of the intubation depth between the new formula, APLS formula, and MFL-based formula. MAIN RESULTS Height (R = 0.897, P < 0.001) was strongly correlated to tracheal length and the endotracheal intubation depth in pediatric patients. New formulae basing on height were established, including new formula 1: D (cm) = 4 + 0.1 × Height (cm) and new formula 2: D (cm) = 3 + 0.1 × Height (cm). Via Bland-Altman analysis, the mean differences for new formula 1, new formula 2, APLS formula and MFL-based formula were - 0.354 cm (95% LOA, -1.289 to 1.998 cm), 1.354 cm (95% LOA, -0.289 to 2.998 cm), 1.154 cm (95% LOA, -1.002 to 3.311 cm), -0.619 cm (95% LOA, -2.960 to 1.723 cm), respectively. The rate of optimal intubation for new formula 1 (84.69%) was higher than for new formula 2 (55.86%), APLS formula (61.26%), and MFL-based formula. (69.37%). CONCLUSIONS The prediction accuracy for intubation depth of the new formula 1 was higher than the other formulae. The new formula based on height: D (cm) = 4 + 0.1 × Height (cm) was preferable to APLS formula and MFL-based formula with a high incidence of appropriate endotracheal tube position.
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Affiliation(s)
- Pei-Er Zhuang
- Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, NO. 57 Changping Road, Jinping District, Shantou, Guangdong Province, China
| | - Jiang-Hong Lu
- Department of Orthopaedics, the First Affiliated Hospital of Shantou University Medical College, NO. 57 Changping Road, Jinping District, Shantou, Guangdong Province, China; Shantou University Medical College, NO. 22 Xinling Road, Jinping District, Shantou, Guangdong Province, China
| | - Wei-Kai Wang
- Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, NO. 57 Changping Road, Jinping District, Shantou, Guangdong Province, China.
| | - Ming-Hua Cheng
- Department of Anesthesiology, the First Affiliated Hospital of Shantou University Medical College, NO. 57 Changping Road, Jinping District, Shantou, Guangdong Province, China
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Ramlan AAW, Sugiharto A, Mutakim A. Accuracy of pediatric advanced life support method for predicting the depth of endotracheal tube in Indonesian children. MEDICAL JOURNAL OF INDONESIA 2021. [DOI: 10.13181/mji.oa.203835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The pediatric advanced life support (PALS) method can predict the depth of endotracheal tube (ETT) in pediatric patients easily, but it has limitations due to variations in the children’s characteristics, especially the racial consideration. This study compared the accuracy of ETT depth prediction based on the PALS methods in Indonesian children.
METHODS Patients aged 0–12 years, who underwent elective surgery with oral intubation, were recruited consecutively based on their ages: 0–24 months and 25 months–12 years for this cross-sectional study in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to August 2014. Bland–Altman analysis was used to compare the two measurement methods: PALS method to predict the ETT depth accuracy and auscultation method to confirm the position of the ETT. Furthermore, correlation analysis was done to examine the relationship of age, weight, height, and ETT internal diameter with ETT depth.
RESULTS 50 patients were recruited in each group. Bland–Altman test of ETT depth in the 0–24 months age group showed a 1.18 cm mean difference from confirmation using the auscultation method (limits of agreement −0.71 to 3.08). The 25 months–12 years age group showed a 1.11 cm mean difference with limits of agreement were −0.95 to 3.17 from confirmation using the auscultation method. Age and weight had the strongest correlation value to ETT depth in the 25 months–12 years age group (R2 = 62.3%).
CONCLUSIONS The PALS method is inaccurate for predicting ETT depth in Indonesian children aged 0–12 years old compared with the auscultation method.
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Rezvani Kakhki B, Miri M, Talebi Doluee M, Sabeti Baygi Z, Abbasi Shaye Z, Vafadar Moradi E. Tactile Method in Confirming Proper Endotracheal Intubation in Emergency Setting; a Letter to Editor. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e38. [PMID: 34223183 PMCID: PMC8221546 DOI: 10.22037/aaem.v9i1.1148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Behrang Rezvani Kakhki
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohsen Miri
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Morteza Talebi Doluee
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Zeynab Sabeti Baygi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mashhad university of Medical Science, Mashhad, Iran
| | - Zahra Abbasi Shaye
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elnaz Vafadar Moradi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
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Abstract
OBJECTIVES To determine if a saline-filled cuff seen at the suprasternal notch on ultrasound corresponds to correct endotracheal tube depth on a chest radiograph (tip at/below clavicle AND ≥ 1 cm above carina). DESIGN Prospective observational study. SETTING Tertiary Care Pediatric hospital. PATIENTS Patients between the ages of 0-18 years requiring nonemergent cardiac catheterizations and endotracheal intubation with a cuffed endotracheal tube were included in the study. Children with anticipated or known difficult airways were excluded. INTERVENTIONS Ultrasound evaluation of the neck following saline inflation of the endotracheal tube cuff. MEASUREMENTS AND MAIN RESULTS Ultrasonography of the patient's neck was performed following intubation by a pediatric anesthesiologist. A linear probe was used in transverse axis to identify the saline-filled cuff starting at the suprasternal notch and moving cephalad. A cine-fluoroscopic image, similar to a chest radiograph, was obtained to ascertain the endotracheal tube depth after the cuff was identified sonographically. Endotracheal tube cuffs seen on ultrasound at the suprasternal notch were compared with the endotracheal tube depth on the cine-fluoroscopic image. A total of 75 children were enrolled in the study. The endotracheal tube was seen sonographically at the suprasternal notch in 70 patients of which 60 had complete data (an adequate chest radiograph available for review). Patient ages ranged from 2 months to 18 years with a median age of 4 years. The median endotracheal tube tip to carina distance was 2.4 cm (interquartile range, 1.75-3.3 cm.) The endotracheal tube tip to carina distance was greater than or equal to 1 cm in 57 out of the 60 patients. Endotracheal tube cuff at the suprasternal notch on ultrasound corresponded with correct endotracheal tube depth on chest radiograph with an accuracy of 95% (CI, 86-98%). CONCLUSIONS Visualization of the cuff at the suprasternal notch by ultrasound demonstrates potential as a means of confirming correct depth of the endotracheal tube following endotracheal intubation.
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Ramsingh D, Ghazal E, Gordon B, Ross P, Goltiao D, Alschuler M, Pugh J, Holsclaw M, Mason L. Relationship Between Evaluations of Tracheal Tube Position Using Ultrasound and Fluoroscopy in an Infant and Pediatric Population. J Clin Med 2020; 9:jcm9061707. [PMID: 32498387 PMCID: PMC7355502 DOI: 10.3390/jcm9061707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/11/2020] [Accepted: 05/28/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure. Airway point-of-care ultrasound (POCUS) has demonstrated utility in children, but the examinations vary by age and may require non-traditional techniques or utilize less common probes. This study evaluated the performance of measuring the tracheal location of the cuffed TT using a novel, linear probe-based POCUS examination over a wide age range of children. After adjusting for the subjects’ height and TT size, ultrasound measurements of the TT cuff location were compared with fluoroscopy measurements of the TT tip location. Methods: Perioperative pediatric patients (<10 years) requiring a cuffed TT were enrolled. After routine TT placement, ultrasound and fluoroscopy images were obtained. Measurements from the TT cuff to the cricoid cartilage were obtained from the POCUS examination. Chest fluoroscopy was reviewed to measure the TT’s distance from the carina. Both measurements were then compared after scaling for patient height. The duration of the ultrasound examination and image quality scores were also recorded. Results: Forty-one patients were enrolled, with a median age of 3 (25th/75th percentile: 1.50/7.00) years. The POCUS examination identified the TT cuff in all cases with the highest image quality score. The median POCUS exam time was 112 (25th/75th percentile: 80.00/156.00) seconds. There was a strong correlation between the POCUS measurements and the fluoroscopy measurements, r = −0.7575, 95% CI [−0.8638, −0.5866 ], p < 0.001). Conclusions: Our results demonstrate a strong correlation between POCUS TT localization measurements and traditional measurements via fluoroscopy. This study further supports the utility of POCUS for pediatric care.
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Affiliation(s)
- Davinder Ramsingh
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA; (E.G.); (P.R.); (D.G.); (M.A.); (J.P.); (M.H.); (L.M.)
- Correspondence: ; Tel.: +1-909-558-4475; Fax: +909-558-0187
| | - Elizabeth Ghazal
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA; (E.G.); (P.R.); (D.G.); (M.A.); (J.P.); (M.H.); (L.M.)
| | - Brent Gordon
- Department of Pediatric Cardiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA;
| | - Philip Ross
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA; (E.G.); (P.R.); (D.G.); (M.A.); (J.P.); (M.H.); (L.M.)
| | - Darren Goltiao
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA; (E.G.); (P.R.); (D.G.); (M.A.); (J.P.); (M.H.); (L.M.)
| | - Matt Alschuler
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA; (E.G.); (P.R.); (D.G.); (M.A.); (J.P.); (M.H.); (L.M.)
| | - Justin Pugh
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA; (E.G.); (P.R.); (D.G.); (M.A.); (J.P.); (M.H.); (L.M.)
| | - Matthew Holsclaw
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA; (E.G.); (P.R.); (D.G.); (M.A.); (J.P.); (M.H.); (L.M.)
| | - Linda Mason
- Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA; (E.G.); (P.R.); (D.G.); (M.A.); (J.P.); (M.H.); (L.M.)
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Singh N, Mohanty CR, Rao PB. Ambiguous pediatric endotracheal tube intubation depth markings: a need for standardization. Korean J Anesthesiol 2019; 72:614-615. [PMID: 30776877 PMCID: PMC6900413 DOI: 10.4097/kja.d.19.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/12/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Neha Singh
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Parnandi Bhaskar Rao
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
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Tube tip and cuff position using different strategies for placement of currently available paediatric tracheal tubes. Br J Anaesth 2018; 121:490-495. [DOI: 10.1016/j.bja.2018.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 12/26/2017] [Accepted: 01/03/2018] [Indexed: 11/23/2022] Open
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Clifford M, Butt W. Tracheal tube insertion is an essential part of modern paediatric anaesthesia and critical care: let us get it right. Br J Anaesth 2018; 116:582-4. [PMID: 27106959 DOI: 10.1093/bja/aew103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Clifford
- Department of Anaesthesia and Pain Management Paediatric Intensive Care Unit, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - W Butt
- Paediatric Intensive Care Unit, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria 3052, Australia
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Kayashima K, Mizuyama H, Takesue M, Doi T, Imai K, Murashima K. Adjusting Pediatric Endotracheal Tube Depths Relative to the Cricoid by Using Longitudinal Ultrasound Images of the Saline-Inflated Cuff in the Trachea: Two Case Reports. A A Pract 2018; 10:235-238. [DOI: 10.1213/xaa.0000000000000673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lee SU, Jung JY, Kim DK, Kwak YH, Kwon H, Cho JH, Park JW, Choi YJ. New decision formulas for predicting endotracheal tube depth in children: analysis of neck CT images. Emerg Med J 2018; 35:303-308. [PMID: 29437848 DOI: 10.1136/emermed-2017-206795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 01/06/2018] [Accepted: 01/22/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The purpose of this study was to construct a prediction model for endotracheal tube depth using neck CT images. METHODS A retrospective image review was conducted that included patients who had undergone neck CT. Using sagittal neck CT images, we calculated the length between upper incisor and mid-trachea and then derived the model via regression analysis. The model was validated externally using chest radiographs of patients who had undergone endotracheal intubation. We compared performance of our model with that of other methods (Broselow tape and APLS formula) via Bland-Altman analysis and the percentage of estimations within 10% of the measured values. RESULTS A total of 1111 children were included in this study. The tube depth obtained from CT images was linearly related to body weight (tube depth (cm)=5.5+0.5×body wt (kg)) in children younger than 1 year and to height (tube depth (cm)=3+0.1×height (cm)) in children older than 1 year. External validation demonstrated that our new model showed better agreement with the desired tube depth than Broselow tape and APLS formula. The mean differences in children younger than 1 year were 0.61 cm and -1.24 cm for our formula and Broselow tape, respectively. The mean differences in children older than 1 year were -0.43 cm, -1.98 and -1.64 cm for our formula, Broselow tape and APLS formula, respectively. The percentages of estimates within 10% of the measured values were 52.7% and 35.8% for our formula and Broselow tape in children younger than 1 year, respectively, and 54.3%, 33.8% and 37.2% for our formula, Broselow tape and APLS formula in children older than 1 year, respectively (P<0.01). CONCLUSION Our new formula is useful and more accurate than the currently available methods.
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Affiliation(s)
- Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seong-nam, Korea
| | - Jun Hwi Cho
- Department of Emergency Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seong-nam, Korea
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Gamble JJ. Three-finger tracheal palpation to guide endotracheal tube depth in children. Paediatr Anaesth 2014; 24:1312-3. [PMID: 25378045 DOI: 10.1111/pan.12562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jonathan J Gamble
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Saskatchewan, Saskatoon, SK, Canada.
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Wang J, Zuo Y. The depth of the tip of the endotracheal tube in children. Paediatr Anaesth 2014; 24:1194-5. [PMID: 25279679 DOI: 10.1111/pan.12520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jiming Wang
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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