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Prediction of appropriate formula for nasotracheal tube size in developmental disability children
Masanori Tsukamoto1, Shiori Taura2, Hitoshi Yamanaka3
1Department of Dental Anesthesiology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. tsukamoto@dent.kyushu-u.ac.jp.
Insights
The age-based formula is most suitable for predicting nasotracheal tube size in children with developmental disabilities. Using a size one smaller than predicted by this formula improves first-attempt intubation success.
Area of Science:
- Pediatric Anesthesiology
- Medical Device Selection
- Developmental Disabilities
Background:
- Children with developmental disabilities exhibit growth variations impacting medical procedures.
- Accurate nasotracheal tube size selection is critical for safe and effective intubation in this population.
- Previous research in healthy children identified height as a predictor, necessitating a specific formula for children with developmental disabilities.
Purpose of the Study:
- To identify the most accurate formula for predicting nasotracheal tube size in children with developmental disabilities.
- To retrospectively evaluate various predictive formulas based on patient characteristics and anatomical measurements.
- To establish a reliable method for intraoperative nasotracheal tube selection in this vulnerable group.
Main Methods:
- Retrospective analysis of 75 children (aged 2-10 years) who underwent nasotracheal intubation.
- Comparison of actually intubated tube sizes with sizes predicted by age, height, weight, and radiographic measurements (C6, C7, T2 vertebral levels).
- Spearman's regression analysis was employed to determine the best-fit predictive formula.
Main Results:
- The age-based formula demonstrated the highest correlation (r²=0.9027) for predicting nasotracheal tube size, outperforming height, weight, and radiographic measurements.
- However, a tube size 0.5 mm smaller than predicted by the age formula showed a higher correspondence rate in actual intubations.
- Correspondence rates for the age-based formula (without size adjustment) were 48% (5.0 mm), 52% (5.5 mm), and 39% (6.0 mm).
Conclusions:
- The age-based formula (ID = 4 + age [years]/4) is the most suitable for predicting nasotracheal tube size in developmental disability children aged 2-10 years.
- Selecting a tube size one smaller than that predicted by the age-based formula is recommended for improved first-trial intubation success.
- This simplified approach may enhance the safety and efficiency of nasotracheal intubation in pediatric patients with developmental disabilities.
Objectives:
Developmental disability children have differences in growth. Therefore, tube size selection is important for nasotracheal intubation. In our previous study for healthy children undergoing dental surgery, height was the most suitable factor to predict nasotracheal tube size. The aim of this study was to find the most suitable formula for selection of nasotracheal tube size for them, retrospectively.
Material And Methods:
Developmental disability children aged 2 to 10 years were included in this study. They were intubated nasotracheally from April 2012 until May 2017. Their actually intubated tube sizes were checked. The predicted tube sizes were calculated according to the formulas by the backgrounds: the diameter of the trachea at the 6th cervical (C6), 7th cervical (C7), and 2nd thoracic vertebrae (T2) in X-ray. The actually intubated tube sizes were compared with predicted sizes. Data were analyzed using Spearman's regression analysis.
Results:
The tube sizes with 5.0, 5.5, and 6.0 mm ID were intubated in 75 patients. The age-based formula was the most suitable; the correlation coefficients (r2) were 0.9027 (vs age), 0.5434 (vs height), 0.3779 (vs weight), 0.0785 (vs C6), 0.2279 (vs C7), and 0.3065 (Th2) (p < 0.01). However, 0.5-mm smaller size tubes were more frequently intubated actually. Their correspondence rate to the predicted size was 48% (5.0 mm), 52% (5.5 mm), and 39% (6.0 mm), respectively.
Conclusion:
The age-based formula could be the most suitable for predicting nasotracheal tube size in developmental disability children aged 2 to 10 years. One smaller size by the age formula was most suitable at first trial tube.
Clinical Relevance:
The present data indicate that the selection of nasotracheal tube using one smaller size by the age formula (ID = 4 + age [years]/4) might be useful for developmental disability children.
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