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Published on: January 17, 2011
Length-based endotracheal tube and emergency equipment in pediatrics
R C Luten1, R L Wears, J Broselow
1Department of Surgery, University of Florida Health Science Center, Jacksonville.
Insights
A new length-based emergency tape accurately selects pediatric endotracheal (ET) tubes, improving upon difficult age-based methods for emergency airway management in children.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Medical Device Development
Background:
- Accurate selection of pediatric endotracheal (ET) tubes is critical for emergency airway management.
- Current age-based methods for ET tube selection are often inaccurate and difficult to recall.
- A reliable length-based system could improve intubation success rates in pediatric emergencies.
Purpose of the Study:
- To develop and validate a specialized emergency tape for length-based selection of pediatric endotracheal tubes.
- To compare the accuracy of length-based ET tube selection with traditional age-based methods.
- To assess the clinical utility and acceptance of the length-based system by anesthesiologists.
Main Methods:
- A derivation set of 205 children had their body length and leak pressures measured to establish ET tube size correlations.
- A validation set of 203 children was used to test the tape's accuracy in selecting ET tube size.
- Length-based selections were compared against two common age-based formulas: (age + 16)/4 and (age + 18)/4.
Main Results:
- The length-based tape selected the appropriate ET tube size with 77% accuracy based on leak pressure criteria.
- The tape provided a size within +/- 0.5 mm of the correct size in 99% of cases.
- Length-based selection was significantly more accurate than age-based rules (47% and 9% correct initial size).
Conclusions:
- A length-based system for emergency equipment selection, including ET tubes, is a valuable tool for pediatric emergency care.
- Length-based ET tube selection demonstrates superior accuracy and ease of use compared to age-based guidelines.
- This system can enhance the efficiency and effectiveness of airway management in critically ill children.
Hypothesis:
Pediatric endotracheal (ET) tubes can be accurately selected based on body length using a specialized emergency tape.
Population:
Derivation set: Two hundred five children undergoing elective surgery. Validation set: Two hundred thirteen children undergoing elective surgery. Each child served as his or her own control.
Methods:
Derivation phase: Two hundred twenty-one children undergoing ET intubation for elective surgery had their body length and leak pressures measured. The 205 children who had leak pressures between 10 and 40 cm H2O constituted the derivation set. The body length for a given ET tube size was derived from the interquartile range of patient lengths in this derivation set. Sizes for other resuscitative equipment items were chosen by a panel of experts using a modified Delphi technique. This information was placed by length on a color-coded tape. Validation phase: The tape was validated by using it to select ET tube size in another group of 203 children undergoing elective surgery. Criteria for acceptable fit in this group included leak pressure as above and the anesthesiologists' decision to accept the tube size or to retintubate. In the validation phase, length-based ET tube selections were compared with age-based rules: (age + 16)/4, and (age + 18)/4.
Results:
The tape selected the appropriate ET tube size by leak pressure criterion in 77% of the cases and was within +/- 0.5 mm of the "correct" size 99% of the time. This was significantly better (P less than .005) than two widely used age-based rules, which gave the correct initial size in only 47% and 9% of these cases, and were within +/- 0.5 mm for 86% and 59%. The anesthesiologists chose to continue with the tape-sized tube rather than to reintubate in 89% of cases.
Conclusion:
A system for length-based selection of emergency equipment represents a significant adjunct to emergency physicians and paramedics who must deal with critically ill children. Length-based ET tube selection is clearly superior to age-based rules, which are difficult to remember and require accurate estimation of a patient's age.
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