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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Examining the pediatric subglottic airway by ultrasound: A systematic review
Ari Saravia1, Rachel W Saravia2, Pamela Mudd3
1Louisiana State University School of Medicine, New Orleans, Louisiana, USA; Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Insights
Ultrasound reliably predicts endotracheal tube size in children, outperforming age-based formulas. This imaging technique aids in preventing intubation-related trauma and ensuring proper ventilation for pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Medical Imaging
- Airway Management
Background:
- Estimating appropriate endotracheal tube (ETT) size in pediatric patients is critical for safe intubation.
- Current methods, such as age-based formulas, have limitations in accuracy.
- Ultrasound (US) offers a potential non-invasive method to assess airway dimensions.
Approach:
- Systematic review of literature from PubMed, Scopus, and Embase databases.
- Included studies focused on pediatric patients (<18 years) using ultrasonography to measure the minimal transverse subglottic airway diameter (MTDSA).
- Primary outcome was the comparison of US-guided ETT size selection against reference standards.
Key Points:
- Sixteen studies involving 1,633 pediatric subjects were analyzed.
- Ultrasound predicted the correct ETT size in 48-100% of cases, compared to 24-95% for age-based formulas.
- Ultrasound demonstrated high predictive value (R2: 0.684-0.980) for ETT sizing, with both methods tending to underestimate size.
Conclusions:
- Transcervical laryngeal ultrasound is a reliable tool for predicting pediatric endotracheal tube size.
- Accurate ETT sizing via ultrasound can minimize intubation-related trauma.
- This technique supports effective ventilation, particularly in cases requiring prolonged intubation.
Objective:
The purpose of this review was to determine the ability of ultrasound (US) to assess the subglottic airway in pediatric patients to estimate the appropriate size of endotracheal tube (ETT).
Data Sources:
Pubmed, Scopus, and Embase databases.
Methods:
A search of the literature was performed for studies that utilized ultrasonography to examine the minimal transverse diameter of the subglottic airway (MTDSA) in the pediatric (age < 18) population to estimate endotracheal tube (ETT) size. Articles were excluded if they involved adults or non-humans, had no comparison method, or were case reports. The primary outcome was the successful use of ultrasound compared to the reference standard defined by the study.
Results:
Sixteen studies were included, for a total of 1,633 pediatric subjects in whom transcervical laryngeal ultrasound was used prospectively to examine the MTDSA to estimate ETT size prior to intubation. Ultrasound reliably predicted the clinically best fit endotracheal tube by air leak test in 48-100% of subjects, while age-based formulas were accurate 24-95% of the time. Ultrasound was highly predictive of proper size, with R2 ranging between 0.684 to 0.980. Of those reintubated (n = 104), 86 (83%) required larger-sized tubes, while 18 (17%) required smaller-sized tubes. Both methods tended to underestimate ETT size, but the age-based formulas accounted for most of these differences.
Conclusion:
Transcervical laryngeal ultrasound appears to be a reliable predictor of endotracheal tube size in children undergoing elective surgery, which has implications for preventing intubation-related trauma and ensuring adequate ventilation for those who may require prolonged intubation.
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