Dataset Information

The accuracy of ultrasound to predict endotracheal tube size for pediatric patients with congenital scoliosis.

ABSTRACT:

Background

Ultrasonography has been used to predict the necessary endotracheal tube (ETT) size by measuring the cricoid cartilage diameter. The aim of this study was to determine the accuracy of ultrasound to predict ETT size for pediatric patients with congenital scoliosis.

Methods

Fifty pediatric patients who underwent scoliosis surgery were included in the study. According to the position of the scoliosis, patients were divided into three groups: Group C (cervical lateral bending), Group T (thoracic scoliosis), and Group L (lumbar scoliosis). For all participants, the transverse diameter of the cricoid cartilage was measured with ultrasonography. The initial ETT size was chosen according to the measurements, then the leak test was used to determine the best-fit ETT size. The ETT size predicted by ultrasound and the best-fit ETT size were compared using Bland-Altman analysis.

Results

There was a strong correlation between the best-fit ETT size and the ETT size predicted by ultrasound in Group T (r = 0.93, p < 0.001) and Group L (r = 0.94, p < 0.001) and a moderate correlation in Group C (r = 0.83, p < 0.001). Bland-Altman analysis showed that the ETT size was overestimated by ultrasound in pediatric patients with cervical lateral bending (bias = 0.73 mm, precision = 0.42 mm, limit of agreement = 0.08 to 1.38 mm).

Conclusion

Ultrasound is a reliable tool to predict ETT size for pediatric patients with thoracic or lumbar scoliosis. However, pediatric patients with cervical lateral bending will need an ETT smaller than the size predicted by ultrasonography.

Trial registration

Chinese Clinical Trial Registry, TRN: ChiCTR1900023408 , date of registration: 05.26.2019, 'retrospectively registered'.

SUBMITTER: Hao J

PROVIDER: S-EPMC7394693 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

The accuracy of ultrasound to predict endotracheal tube size for pediatric patients with congenital scoliosis.

Hao Jianhong J Zhang Jie J Dong Buhuai B Luo Zhenguo Z

BMC anesthesiology 20200731 1

<h4>Background</h4>Ultrasonography has been used to predict the necessary endotracheal tube (ETT) size by measuring the cricoid cartilage diameter. The aim of this study was to determine the accuracy of ultrasound to predict ETT size for pediatric patients with congenital scoliosis.<h4>Methods</h4>Fifty pediatric patients who underwent scoliosis surgery were included in the study. According to the position of the scoliosis, patients were divided into three groups: Group C (cervical lateral bendi ...[more]

PMID: 32736523

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Project description:ImportanceMany patients who survive critical illness are left with laryngeal functional impairment from endotracheal intubation that permanently limits their recovery and quality of life. Although the risk for laryngeal injury increases with larger endotracheal tube sizes, there are no data delineating the association of smaller endotracheal tube sizes with survival or acute recovery from critical illness.ObjectiveTo determine if smaller endotracheal tubes are noninferior to larger endotracheal tubes with respect to critical illness outcomes.Design, setting, and participantsThis propensity score-matched retrospective cohort study included all adult patients who underwent endotracheal intubation in the emergency department or intensive care unit and received mechanical ventilation for at least 12 hours from June 2020 to November 2020 at a single tertiary referral academic medical center.ExposuresEndotracheal intubation.Main outcomes and measuresPropensity score-matched analyses were performed with respect to the primary end point of 30-day all-cause in-hospital survival as well as the secondary end points of duration of invasive mechanical ventilation, length of hospital stay, mean peak inspiratory pressure, 30-day readmission, need for reintubation, and need for tracheostomy or gastrostomy tube placement.ResultsOverall, 523 participants (64%) were men and 291 (36%) were women. Of these, 814 patients were categorized into 3 endotracheal tube groups: small for height (n = 182), appropriate for height (n = 408), and large for height (n = 224). There was not a significant difference in 30-day all-cause in-hospital survival between groups ([HR, 1.1; 95% CI, 0.7-1.7] for small vs appropriate; [HR, 1.1; 95% CI, 0.7-1.6] for large vs appropriate). Patients with small-for-height endotracheal tubes had longer intubation durations (mean difference, 32.5 hrs [95% CI, 6.4-58.6 hrs]) compared with patients with appropriate-for-height tubes.Conclusions and relevanceDespite differences in intubation duration, the results of this cohort study suggest that smaller endotracheal tube sizes are not associated with impaired survival or recovery from critical illness. They support future prospective exploration of the association of smaller endotracheal tube sizes with recovery from critical illness.

Project description:ObjectiveWe aimed to construct and validate machine learning models for endotracheal tube (ETT) size prediction in pediatric patients.MethodsData of 990 pediatric patients underwent endotracheal intubation were retrospectively collected between November 2019 and October 2021, and separated into cuffed and uncuffed endotracheal tube subgroups. Six machine learning algorithms, including support vector regression (SVR), logistic regression (LR), random forest (RF), gradient boosting tree (GBR), decision tree (DTR) and extreme gradient boosting tree (XGBR), were selected to construct and validate models using ten-fold cross validation in training set. The optimal models were selected, and the performance were compared with traditional predictive formulas and clinicians. Furthermore, additional data of 71 pediatric patients were collected to perform external validation.ResultsThe optimal 7 uncuffed and 5 cuffed variables were screened out by feature selecting. The RF models had the best performance with minimizing prediction error for both uncuffed ETT size (MAE = 0.275 mm and RMSE = 0.349 mm) and cuffed ETT size (MAE = 0.243 mm and RMSE = 0.310 mm). The RF models were also superior in predicting power than formulas in both uncuffed and cuffed ETT size prediction. In addition, the RF models performed slightly better than senior clinicians, while they significantly outperformed junior clinicians. Based on SVR models, we proposed 3 novel linear formulas for uncuffed and cuffed ETT size respectively.ConclusionWe have developed machine learning models with excellent performance in predicting optimal ETT size in both cuffed and uncuffed endotracheal intubation in pediatric patients, which provides powerful decision support for clinicians to select proper ETT size. Novel formulas proposed based on machine learning models also have relatively better predictive performance. These models and formulas can serve as important clinical references for clinicians, especially for performers with rare experience or in remote areas.

Project description:BackgroundSubglottic secretion had been proven as one of the causes of microaspiration and increased risk of ventilator-associated pneumonia (VAP). The role of ultrasound to detect subglottic secretion has not yet been established.PurposeThe purpose of this study is to determine the sensitivity and specificity of upper airway ultrasound (US) in the detection of subglottic secretions as compared to computed tomography (CT) scanning.Material and methodsA prospective observational study was carried out in adult trauma patients requiring mechanical ventilation and cervical CT scan. All patients had an endotracheal tube cuff-pressure maintained between 20 and 30 cm H2O. Airway US was performed at the bedside immediately before the patient was transferred to the CT scan suite. The sensitivity, specificity, and positive/negative predictive values (PPV, NPV) of the upper airway US detection of subglottic secretions were then calculated and compared with CT findings.ResultsFifty participants were consecutively included. Subglottic secretions were detected in 31 patients using upper airway US. The sensitivity and specificity of upper airway US in detecting subglottic secretion were 96.7% and 90%, respectively (PPV 93.5%, NPV 94.7%). 18 (58%) patients with subglottic secretions developed VAP during their ICU stay (p = 0.01). The area under the receiver operating curve (AUROC) was 0.977 (95% CI 0.936-1.00).ConclusionsUpper airway US is a useful tool for detecting subglottic secretions with high sensitivity and specificity.Clinical implicationsThis study shows: 1. Upper airway US may aid in detecting subglottic secretions, which are linked to VAP. 2. Detecting subglottic secretions at the bedside aids in determining the best frequency of subglottic aspiration to clean the subglottic trachea. 3. Upper airway US may also aid in detecting the correct ETT position. Trial registration Clinicaltrials.gov.Clinicaltrialsgov identifier NCT04739878 Date of registration 2nd May 2021 URL of trial registry record https://clinicaltrials.gov/ct2/show/NCT04739878 .

Project description:BACKGROUND:Endotracheal tube (ETT) placement is a critical procedure for newborns that are unable to breathe. Inadvertent esophageal intubation can lead to oxygen deprivation and consequent permanent neurological impairment. Current standard-of-care methods to confirm ETT placement in neonates (auscultation, colorimetric capnography, and chest x-ray) are time consuming or unreliable, especially in the stressful resuscitation environment. Point-of-care ultrasound (POCUS) of the neck has recently emerged as a powerful tool for detecting esophageal ETTs. It is accurate and fast, and is also easy to learn and perform, especially on children. METHODS:This will be an observational diagnostic accuracy study consisting of two phases and conducted at the Aga Khan University Hospital in Karachi, Pakistan. In phase 1, neonatal health care providers that currently perform standard-of-care methods for ETT localization, regardless of experience in portable ultrasound, will undergo a two-hour training session. During this session, providers will learn to detect tracheal vs. esophageal ETTs using POCUS. The session will consist of a didactic component, hands-on training with a novel intubation ultrasound simulator, and practice with stable, ventilated newborns. At the end of the session, the providers will undergo an objective structured assessment of technical skills, as well as an evaluation of their ability to differentiate between tracheal and esophageal endotracheal tubes. In phase 2, newborns requiring intubation will be assessed for ETT location via POCUS, at the same time as standard-of-care methods. The initial 2 months of phase 2 will include a quality assurance component to ensure the POCUS accuracy of trained providers. The primary outcome of the study is to determine the accuracy of neck POCUS for ETT location when performed by neonatal providers with focused POCUS training, and the secondary outcome is to determine whether neck POCUS is faster than standard-of-care methods. DISCUSSION:This study represents the first large investigation of the benefits of POCUS for ETT confirmation in the sickest newborns undergoing intubations for respiratory support. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.

Dataset Information

The accuracy of ultrasound to predict endotracheal tube size for pediatric patients with congenital scoliosis.

Background

Methods

Results

Conclusion

Trial registration

Publications

The accuracy of ultrasound to predict endotracheal tube size for pediatric patients with congenital scoliosis.

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