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Derivation and validation of a formula for paediatric tracheal tube size using bootstrap resampling procedure

M Ganesh Kumar1, Meenakshi Atteri2, Yatindra K Batra3

  • 1Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Indian Journal of Anaesthesia
|July 3, 2019
PubMed

Insights

Child length accurately predicts uncuffed tracheal tube size better than age or weight. A new formula, the Paediatric Tube Size Predictor (PTSP), based on length, correctly identifies the optimal uncuffed tracheal tube size in 75% of children.

Area of Science:

  • Pediatric Anesthesiology
  • Airway Management
  • Medical Device Sizing

Background:

  • Accurate uncuffed tracheal tube (TT) size selection is critical for pediatric airway management.
  • Existing age-, length-, and weight-based formulas show variable accuracy in predicting optimal TT size.
  • There is a need for a reliable method to determine appropriate TT size in Indian children.

Purpose of the Study:

  • To evaluate the predictive accuracy of age, length, and weight for uncuffed TT size in Indian children.
  • To derive and validate a new formula for predicting uncuffed TT size using the most accurate predictor.
  • To improve the safety and efficacy of tracheal intubation in pediatric patients.

Main Methods:

  • Prospective study of 100 children (1-8 years) undergoing general anesthesia and tracheal intubation.
  • Leak test used to confirm correct uncuffed TT size.
  • Bootstrap resampling to assess predictors (age, weight, length) and their combinations.
  • Derivation of the Paediatric Tube Size Predictor (PTSP) formula.
  • Validation of PTSP in a separate cohort of 150 children.

Main Results:

  • Child length (L, in meters) was the best single predictor of uncuffed TT size (R² = 0.61).
  • The derived PTSP formula is: internal diameter = 3L + 2.5.
  • PTSP demonstrated 75% accuracy in predicting the correct uncuffed TT size in the validation cohort.
  • Re-intubation was linked to increased respiratory morbidity compared to single tracheal intubation.

Conclusions:

  • Child length is a superior predictor of uncuffed TT size compared to age and weight.
  • The PTSP formula, utilizing child length, provides accurate uncuffed TT size prediction in 75% of pediatric cases.
  • The PTSP formula offers a valuable tool for optimizing uncuffed TT selection in pediatric patients, potentially reducing complications.
Abstract

Keywords:
Anaesthesiabody heightendotrachealintratrachealintubationpaediatrictracheal tube size

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