Ultrasound versus traditional formula for subglottic diameter-based uncuffed endotracheal tube selection in pediatric...

Accurate endotracheal tube (ETT) size selection is vital in pediatric anesthesia, yet traditional age-based formulas such as the modified Cole's formula are often unreliable; ultrasonography (USG), by directly visualizing the subglottic airway, offers a more precise alternative. In a cross-sectional study of 75 children aged 1-8 years, elective cases underwent ultrasound measurement of the mean transverse subglottic diameter, while emergency cases relied on the age-based formula. Ultrasound demonstrated superior accuracy, reducing ETT changes (5% vs. 20%), second intubation attempts (5% vs. 20%) and post-intubation complications (4.5% vs. 16.5%). It also showed higher sensitivity (100% vs. 96%) for predicting appropriate tube size. Thus, we show ultrasonography as a more reliable method than traditional formulas and recommend its integration into routine pediatric airway assessment.