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Choosing endotracheal tube size in children: Which formula is best?
Ria Manimalethu1, Senthil Krishna2, Shabana Z Shafy2
1The Ohio State University College of Medicine, Columbus, OH, USA.
Insights
The Duracher formula is the best choice for selecting cuffed endotracheal tube sizes in children, reducing the need for tube changes and postoperative adverse events like stridor.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
Background:
- Selecting the correct endotracheal tube size is crucial for pediatric intubation.
- Several formulas exist, but their comparative efficacy for cuffed tubes is not well-established.
Purpose of the Study:
- To prospectively compare three common formulas (Duracher, Cole, Khine) for selecting cuffed endotracheal tube sizes in children.
Main Methods:
- 135 pediatric patients were randomized to have their endotracheal tube size determined by one of three formulas.
- Tube fit, intracuff pressure, and postoperative adverse events (stridor, throat pain, hoarseness) were assessed.
Main Results:
- No significant differences were observed in intracuff pressure or airway sealing volume among the groups.
- The Duracher formula group required no endotracheal tube changes, unlike the Cole group (p < 0.05).
- The Cole group experienced a higher incidence of postoperative adverse events compared to the Duracher group.
Conclusions:
- The Duracher formula is recommended for selecting cuffed endotracheal tube sizes in pediatric patients.
- This formula optimizes airway management and reduces post-procedure complications.
Objectives:
Various formulae have been suggested to calculate the appropriate sized endotracheal tube in children. The current study prospectively compares three commonly used formulae for selection of cuffed endotracheal tubes in children.
Methods:
Patients were randomized to one of three formulae (Duracher, Cole, or Khine) to determine the size of the cuffed endotracheal tube for endotracheal intubation. The fit of the tube was noted and intracuff pressure was measured using a manometer. The postoperative incidence of stridor, throat pain/soreness, and hoarseness was noted in the post-anesthesia care unit at 2, 4 and 24 h after the procedure.
Results:
The study cohort included 135 patients less than or equal to 8 years, equally divided into three groups based on age, weight, and gender. There was no difference in the intracuff pressure, the volume required to seal the airway, or the number of times in which the intracuff pressure was greater than or equal to 20 or 30 cm H2O among the three groups. Six tube changes were required in the Cole group while no tube changes were required in the Duracher group (p < 0.05). The postoperative incidence of adverse events (throat pain, hoarseness, and stridor) at 0-2 h, 2-4 h, and 24 h was higher in the Cole group when compared to the Duracher group.
Conclusion:
When using an endotracheal tube with a polyurethane cuff, the Duracher formula provided the best estimate for choosing the correct size.
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