The Accuracy of The Ultrasound Measured Transverse Cricoid Diameter and The Epiphyseal Transverse Diameter of the Distal Radius in Predicting the Pediatric Endotracheal Tube Size.

Faculty of Medicine

Assiut University

The Accuracy of The Ultrasound Measured Transverse Cricoid Diameter and The Epiphyseal Transverse Diameter of the Distal Radius in Predicting the Pediatric Endotracheal Tube Size.

Research Authors
Abdel-Ghaffar, Hala; Assiut University Faculty of Medicine OH, Thabet; Assiut University Faculty of Medicine YH, Abbas; Assiut University Faculty of Medicine NYM, El-hagagy; Assiut University Faculty of Medicine ABEDALMOHSEN, ABUALAUON; Assiut University
Research Date
Research Department
Department of  Anesthesia and Intensive Care
Research Journal
pediatric anesthesia journal
Research Member
Abualauon Mohamed Abedalmohsen Rashwan
Research Publisher
Wiley
Research Year
2023
Research Abstract

Abstract:

 

Background: In everyday pediatric anesthesia practice, clinicians frequently exchange an already inserted endotracheal tube because of a leak or resistance causing significant morbidity. We investigated the accuracy of two ultrasound measurements; the transverse cricoid diameter and epiphyseal diameter of the distal radius in the prediction of endotracheal tube size that best fits in children compared to age-based formulas.

 

Patients: One hundred children (1–6 years) who underwent elective surgery with endotracheal tube whether cuffed (n=50) or uncuffed (n=50) were enrolled. The primary endpoint was the agreement between the reference tube size for which its outer diameter selected based on transverse cricoid diameter and the final Best-Fit-ETT. The Correlation and Bland Altman agreement tests were conducted between Best-Fit-ETT outer diameter and ultrasound measured outer diameter, and between Best-Fit-ETT inner diameter and inner diameter calculated by agebased formulas.

 

Results: The agreement rate between transverse cricoid diameter based endotracheal tube size and Best-Fit-ETT size was 88% in cuffed group compared to 90% in uncuffed group. A significant positive correlation was reported between the outer diameter of Best-Fit-ETT, and the outer diameter measured by the two ultrasound methods. A lower degree of positive correlation was reported between the inner diameter of Best-Fit-ETT, and the inner diameter calculated by age-based formulas. Bland Altman's analysis showed agreement between Best-Fit-ETT outer diameter and epiphyseal diameter of the distal radius in both groups and with transverse cricoid diameter in the cuffed group, with no agreement with age-based formulas in either group.

 

Conclusions: Both transverse cricoid diameter and epiphyseal diameter of the distal radius are reliable predictors of the size of Best-Fit-ETT pediatric endotracheal tube compared to age-based formulas. To save time and effort, we recommend the US measurement of the epiphyseal diameter of distal radius in the preoperative visit and documenting the predicted tube size with the preoperative assessments.  

 

Key Words: Children, Endotracheal tube size, prediction, ultrasound, subglottic, distal radius.

 

Trial registration: ClinicalTrials.gov (Identifier: NCT03560895).