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Tracheal Size and Morphology on the Reconstructed CT Imaging*

Mizuguchi, Soichi MD1,2; Motomura, Yoshitomo MD, PhD1,2; Maki, Jun MD, PhD3; Baba, Rieko MD1,2; Ichimiya, Yuko MD1,2; Tokuda, Kentaro MD, PhD3; Kaku, Noriyuki MD, PhD1,2; Takada, Hidetoshi MD, PhD1; Maehara, Yoshihiko MD, PhD2; Ohga, Shouichi MD, PhD1

Pediatric Critical Care Medicine: August 2019 - Volume 20 - Issue 8 - p e366-e371
doi: 10.1097/PCC.0000000000001996
Online Clinical Investigations

Objectives: To characterize the real size and morphology of tracheas in childhood for the optimal selection of endotracheal tube.

Design: A retrospective cohort study of pediatric patients who received CT scan of the cervical spine from July 2011 to March 2018. Cross-sectional CT images vertical to trachea were reconstructed and the accurate tracheal diameters were measured. The validity of the traditional age-based formula for predicting the endotracheal tube size was assessed for the best fit to trachea.

Setting: Tertiary Emergency and Critical Care Center of Kyushu University Hospital.

Patients: Children, who are 1 month to 15 years old, received CT scan of the cervical spine.

Interventions: None.

Measurements and Main Results: We enrolled 86 children with median age of 53 months. The cross-sectional shape of pediatric trachea was circular at the cricoid level and elliptical at the infraglottic level. The narrowest part of pediatric trachea was the transverse diameter at the infraglottic level at any age. Significant positive correlation between age and the narrowest diameter was observed. When compared the transverse diameter at the infraglottic level with the outer diameter of endotracheal tubes, uncuffed endotracheal tubes selection based on the traditional age-based formula ran a significant risk of oversized endotracheal intubation until 10 years old compared with cuffed endotracheal tubes selection (60.0% vs 23.8%; p < 0.05).

Conclusions: These findings indicate the safety and efficacy of cuffed endotracheal tubes in infants and children and the reconsideration for the airway management in pediatric anesthesia and intensive care.

1Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

2Emergency and Critical Care Center, Kyushu University, Fukuoka, Japan.

3Intensive Care Unit, Kyushu University Hospital, Fukuoka, Japan.

*See also p. 789.

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Drs. Maki and Baba disclosed work for hire. The remaining authors disclosed that they do not have any potential conflicts of interest.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies