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Pediatric tracheal dimensions on computed tomography and its correlation with tracheostomy tube sizes
P Naina1, Kamran Asif Syed1, Aparna Irodi2
1Department of ENT, Christian Medical College, Vellore, India.
Insights
This study measured Indian children's tracheal dimensions using CT scans. Findings show current tracheostomy tubes have appropriate diameters but excessive length, suggesting a need for design modification.
Area of Science:
- Pediatric Otolaryngology
- Medical Imaging
- Anatomy
Background:
- Standard tracheostomy tube selection in children relies on age-based formulas.
- Accurate tracheal dimensions are crucial for appropriate tube sizing and patient safety.
Purpose of the Study:
- To measure tracheal dimensions in Indian children using CT scans.
- To compare these dimensions with existing age-appropriate tracheostomy tube sizes.
- To inform potential modifications in tracheostomy tube design.
Main Methods:
- Utilized CT scans from 214 Indian children under 16 years old.
- Calculated tracheal diameter and length at the tracheostomy site.
- Correlated measurements with age, weight, and height.
Main Results:
- Tracheal diameter showed a strong correlation with age and weight (P=0.04, P=0.001).
- Tracheal length correlated well with age and height (P=0.03, P<0.001).
- Tracheal diameter correlated with tracheostomy tube outer diameter, but tube length exceeded ideal measurements.
Conclusions:
- Existing tracheostomy tube diameters are suitable for Indian children based on tracheal size.
- The length of current tracheostomy tubes is often excessive, increasing risks like endobronchial intubation.
- A revision in tracheostomy tube design is recommended to improve patient outcomes.
Objective:
Age-based formulas for selecting the appropriate size of tracheostomy tubes in children are based on data on tracheal dimensions. This study aims to measure the tracheal dimensions of Indian children by computerized tomography (CT) and to compare this with the dimensions of age-appropriate tracheostomy tubes.
Methods:
CT scans of children aged less than 16 years that were taken for indications other than respiratory distress were included. Tracheal diameters at the tracheostomy point and tracheal length from the tracheostomy point to the carina were calculated from the scans. These dimensions were correlated with age, weight, and height. The measurement on the CT scan was used to predict the appropriate size of tracheostomy tube, which was compared with the tracheostomy tube sizes.
Results:
Two hundred and fourteen CT scans of children aged below 16 years were included in the study. On multiple logistic regression analysis, tracheal diameter correlated well with age and weight (P = 0.04 and 0.001, respectively), whereas tracheal length correlated well with age and height of the child (P = 0.03 and 0 < 0.001, respectively). On comparison with dimensions of the tracheostomy tube, tracheal diameter correlated well, and the length was found to be longer than needed to prevent endobronchial intubation. The regression value was used to predict the size of an ideal tracheostomy tube.
Conclusion:
Tracheal diameter of Indian children correlates well with the outer diameter of age-appropriate tracheostomy tubes, but the length of these tubes is longer than the ideal length. This would necessitate a change in the design of these tubes.
Level Of Evidence:
2b Laryngoscope, 130:1316-1321, 2020.
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