Endotracheal Tube Size Estimation for Children With Pathological Short Stature : Pediatric Emergency Care

Secondary Logo

Journal Logo

Advanced Search
Original Articles

Endotracheal Tube Size Estimation for Children With Pathological Short Stature

Daugherty, Reza James MD*; Nadkarni, Vinay MD†; Brenn, Bruce Randall MD‡

Author Information

*Division of Pediatric Emergency Medicine and †Department of Pediatric Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA and ‡Department of Anesthesia and Critical Care, The A.I. duPont Hospital for Children, Wilmington, DE.

Dr Daugherty is now in the Division of Pediatric Emergency Medicine, The A.I. duPont Hospital for Children, Wilmington, DE.

The work described herein was presented at the Pediatric Academic Societies Annual Meeting, Washington, DC, May 2005. This work did not receive any external financial support.

Address correspondence and reprint requests to Reza J. Daugherty, MD, Division of Pediatric Emergency Medicine, The A.I. duPont Hospital for Children, Wilmington, DE 19899. E-mail: [email protected].

Pediatric Emergency Care 22(11):p 710-717, November 2006. | DOI: 10.1097/01.pec.0000238743.96606.69

Abstract

Objective: 

To compare length-based estimates of endotracheal tube (ETT) size and age-based estimates with anesthesiologist-selected ideal ETT size in children with medical conditions affecting normal growth, known as pathological short stature (PSS).

Methods: 

We conducted a retrospective review of the anesthesia database of all children undergoing tracheal intubation for any surgical procedure during a 3-year period. The anesthesiologist-selected ideal ETT size was defined as that selected and successfully used throughout the case under the supervision of a board-certified pediatric anesthesiologist. Objective criteria, such as leak test and adequate oxygenation/ventilation, were used to validate the appropriateness of the ETT chosen. For analysis, the children were classified as normal length for age versus PSS, defined as less than 5% length for age on the Centers for Disease Control and Prevention growth chart. The proportions of clinically relevant predicted ETTs, within ±0.5 mm of the anesthesiologist-selected ideal ETT size, based on both age- and length-based formulas for each group were then compared.

Results: 

Five thousand one hundred seventy-five patient records were analyzed. In children with normal stature, age-predicted ETT size was within the clinically relevant range in 89.8% (95% confidence interval [CI], 88.9%-90.7%), and length-predicted ETT size was within the clinically relevant range in 92.8% (95% CI, 92.0%-93.6%). In children with PSS, age-predicted ETT size was within the clinically relevant range in 86.6% (95% CI, 84.3%-89.0%), and length-predicted ETT size was within the clinically relevant range in 92.2% (95% CI, 90.3%-94.0%). The correlation coefficient for age to anesthesiologist-selected ideal ETT size was strong for both normal and PSS patients (r = 0.91 and r = 0.93, respectively). Length was also highly correlated to actual ETT size used for both groups (r = .91).

Conclusions: 

Length-based prediction of ETT size is at least as accurate as age-based estimation in both normal and pathologically short children.

© 2006 Lippincott Williams & Wilkins, Inc.

Full Text Access for Subscribers:

Not a Subscriber?

Buy
Request Permissions

You can read the full text of this article if you:

Access through Ovid