GKD Anest Yoð Bak Dern Derg. 2021; 27(1): 96-102 | DOI: 10.5222/GKDAD.2021.37167

Measurement of the Endotracheal Tube Diameter Using Computed Tomography Images for Pediatric Patients: Comparison with Classic Formulas

Hatice Dilek Özcanoðlu¹, Berna Türkay², Neþe Kutlutürk Þahin³, Zahide Özlem Ulubay², Ayþe Sevinc Revanlý², Kamil Toker^4
1Anesthesiology, Baþakþehir Çam And Sakura City Hospital, Istanbul, Turkey.
²Anesthesiology, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training And Research Hospital, Istanbul, Turkey.
³Department Of Radiology, Beykent University, Istanbul, Turkey
⁴Department Of Anesthesiology And Reanimation, Faculty Of Medicine, Ýstinye University, Istanbul, Turkey

Objective: In this retrospective study, we aimed to evaluate the compatibility of endotracheal tube (ETT) size used during surgery with tracheal diameter measured by computed tomography(CT) and classic formulas in children who underwent CT imaging preoperatively due to surgical indications.
Methods: The study included preoperatively CT scanned, 0-3 year-old patients who were operated due to congenital heart diseases between June 1-October 1, 2018.Using the CT scans, transverse and anteroposterior tracheal diameters were measured from the subglottic level. As these diameters reflect the external diameter of the ETT, the inner diameter-which corresponds the ETT size-was calculated using a correction formula. Besides, Cole’s formula was used to calculate the ETT size for each child, and the tube sizes used during surgeries were obtained from anesthesia charts.ETT sizes were compared.
Results: 43 patients (22 girls [51.2%],21 boys [48.8%]) were included.The mean age was 10.5±9.6 months. 18 patients (41.9%) had cyanotic, 25 patients (58.1%) had acyanotic heart disease.Mean corrected transverse and anteroposterior tracheal diameters at CT images were 4.35±0.69mm and 4.30±0.71 mm, respectively. The mean diameter calculated by Cole’s formula was 4.22±0.20 mm. The mean tube size used during surgeries was 4.37±0.60 mm. There was no statistically significant difference between the tube sizes used during the surgeries and the corrected transverse tracheal diameters from CT measurements (p>0.05). But the tube sizes used during the surgeries found significantly larger than the diameters obtained by Cole’s formula (p<0.05).
Conclusion: In 0-3 years of age pediatric patients who undergo a congenital heart surgery,corrected tracheal transverse diameter measured by CT is more effective,reliable and less invasive than classic formulas for determining appropriate ETT size

Keywords: Pediatric endotracheal tube size, subglottic diameter, computed tomography, Cole’s formula

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Pediatrik Hastalarda Bilgisayarlý Tomografi Kullanýlarak Endotrakeal Tüp Çapýnýn Belirlenmesi: Klasik Formüllerle Karþýlaþtýrma

Hatice Dilek Özcanoðlu¹, Berna Türkay², Neþe Kutlutürk Þahin³, Zahide Özlem Ulubay², Ayþe Sevinc Revanlý², Kamil Toker^4
1Baþakþehir Çam Ve Sakura Þehir Hastanesi Anestezi Ve Reanimasyon Kliniði Ýstanbul
²Saðlýk Bilimleri Üniversitesi Mehmet Akif Ersoy G.K.D.C. Eðitim Ve Araþtýrma Hastanesi Anestezi Kliniði,i̇stanbul
³Beykent Üniversitesi Radyoloji Kliniði, Ýstanbul
⁴Ýstinye Üniversitesi Týp Fakültesi Anestezi Ve Reanimasyon Kliniði, Ýstanbul

Amaç: Bu retrospektif çalýþmada, ameliyat öncesi bilgisayarlý tomografi çekilmiþ ve kalp cerrahisi yapýlmýþ pediyatrik hastalarda, kullanýlan tüp numarasýnýn, ölçülen trakea çapý ile ve klasik formüllerle uygunluðu karþýlaþtýrýldý.
Yöntem: 1 Haziran 2018-1 Ekim 2018 tarihleri arasýnda, konjenital kalp hastalýðý nedeniyle opere edilmiþ ve ameliyat öncesinde trakea ölçümü yapýlacak þekilde bilgisayarlý tomografi çekilmiþ olan 0-3 yaþ aralýðýndaki hastalar çalýþmaya dâhil edildi. Trakeal BT’de subglottik seviyede transvers çap ve anteroposterior çap ölçüldü. Bu çaplar ETT dýþ çapýný yansýtmalarý nedeniyle bir düzeltme formülü kullanýlarak ETT numarasýna karþýlýk gelen iç çap hesaplandý. Ayrýca Cole formülüne göre, her çocuða uygun ETT çapý hesaplandý ve anestezi dosya kayýtlarýndan cerrahide uygulanan ETT numaralarý kaydedildi. Uygulanan tüp numaralarý, Cole formülüyle hesaplanan tüp numaralarý ve trakeal BT’deki ölçümle belirlenmiþ olan ETT numaralarý ile karþýlaþtýrýldý.
Bulgular: Kýrk üç olgu mevcuttu. Olgularýn %51.2’si (n=22) kýz, %48.8’i (n=21) erkek ve yaþ ortalamasý 10,5±9.6 aydý. Hastalarýn %41.9’unda (n=18) siyanotik konjenital kalp hastalýðý, %58.1’inde (n=25) asiyanotik konjenital kalp hastalýðý vardý. Altý hasta (%14.0) Down Sendromlu, 4 hasta ise redo-olguydu (%9.3). Trakeal BT’de, trakea transvers çapý ölçümüne göre düzeltilmiþ tüp çapý ortalamasý 4.35±0.69 mm, trakea anteroposterior çapý ölçümüne göre düzeltilmiþ tüp çapý ortalamasý 4.30±0.71 mm, Cole formülü ile hesaplanan tüp çapý 4.22±0.20 mm ve klinikte uygulanan tüp çapý 4.37±0.60 mm idi. Ameliyatlarda uygulanan tüp çaplarý ile düzeltilmiþ trakea transvers ölçüm çaplarý arasýnda istatistiksel olarak anlamlý fark yoktu (p>0.05). Fakat ameliyatlarda uygulanan tüp çaplarý, Cole formülü ile hesaplanan tüp çaplarýna göre anlamlý oranda büyük bulundu (p=0.03).
Sonuç: Pediyatrik kalp cerrahisi geçiren 0-3 yaþ arasý çocuklarda endotrakeal tüp çapýnýn belirlenmesinde bilgisayarlý tomografi ile ölçülen düzeltilmiþ trakea transvers ölçüm çaplarý, klasik formüllere göre daha etkin, güvenilir ve non invaziv bir yöntemdir.

Anahtar Kelimeler: Pediatrik endotrakeal tüp numarasý, subglottik çap, bilgisayarlý tomografi, Cole formülü

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