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Airway management in children: ultrasonography assessment of tracheal intubation in real time?
Anesth Analg. 2009 Feb; 108(2):461-5.A&A

Abstract

BACKGROUND

Pediatric tracheal intubation requires considerable expertise and can represent a challenge to many anesthesiologists. Confirmation of correct tracheal tube position relies on direct visualization or indirect measures, such as auscultation and capnography. These methods have varying sensitivity and specificity, especially in the infant and young child. Ultrasonography is noninvasive and is becoming more readily available to the anesthesiologist. In this study, we investigated the characteristic real-time ultrasonographic findings of the normal pediatric airway during tracheal intubation and its suitability for clinical use.

METHODS

Thirty healthy children with normal airways requiring tracheal intubation were studied. Ultrasonographic measurements of the pediatric airway during tracheal intubation under deep inhaled anesthesia were performed using a Sonosite Titan (Sonosite, Bothell, WA) scanner while recording characteristic images during this process. Correct tracheal tube placement was further confirmed using auscultation and satisfactory end-tidal capnography.

RESULTS

The mean (+/- sd) age of studied patients was 48 +/- 37 mo, weight was 19.7. +/- 8.6 kg and the sex ratio (m/f) was 1:2. Successful tracheal intubation was verified using the following criteria: 1) identification of the trachea and tracheal rings, 2) visualization of vocal cords, 3) widening of glottis as the tracheal tube passes through, and 4) tracheal tube position above carina and demonstration of movement of the chest wall visceroparietal pleural interface (i.e., sliding sign) after manual ventilation of the lungs. One esophageal intubation was readily recognized by visualization of the tube in the left paratracheal space.

CONCLUSION

This study describes characteristic ultrasonographic findings of the pediatric airway during tracheal intubation. It suggests that ultrasonography may be useful for airway management in children.

Authors+Show Affiliations

Pôle d'Anesthésie Réanimation, Hôpital Jeanne de Flandre, CHRU, Rue Eugène Aviné, 59037 Lille Cedex France. bmarciniak@chru-lille.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19151273

Citation

Marciniak, Bruno, et al. "Airway Management in Children: Ultrasonography Assessment of Tracheal Intubation in Real Time?" Anesthesia and Analgesia, vol. 108, no. 2, 2009, pp. 461-5.
Marciniak B, Fayoux P, Hébrard A, et al. Airway management in children: ultrasonography assessment of tracheal intubation in real time? Anesth Analg. 2009;108(2):461-5.
Marciniak, B., Fayoux, P., Hébrard, A., Krivosic-Horber, R., Engelhardt, T., & Bissonnette, B. (2009). Airway management in children: ultrasonography assessment of tracheal intubation in real time? Anesthesia and Analgesia, 108(2), 461-5. https://doi.org/10.1213/ane.0b013e31819240f5
Marciniak B, et al. Airway Management in Children: Ultrasonography Assessment of Tracheal Intubation in Real Time. Anesth Analg. 2009;108(2):461-5. PubMed PMID: 19151273.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Airway management in children: ultrasonography assessment of tracheal intubation in real time? AU - Marciniak,Bruno, AU - Fayoux,Pierre, AU - Hébrard,Anne, AU - Krivosic-Horber,Renée, AU - Engelhardt,Thomas, AU - Bissonnette,Bruno, PY - 2009/1/20/entrez PY - 2009/1/20/pubmed PY - 2009/2/10/medline SP - 461 EP - 5 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 108 IS - 2 N2 - BACKGROUND: Pediatric tracheal intubation requires considerable expertise and can represent a challenge to many anesthesiologists. Confirmation of correct tracheal tube position relies on direct visualization or indirect measures, such as auscultation and capnography. These methods have varying sensitivity and specificity, especially in the infant and young child. Ultrasonography is noninvasive and is becoming more readily available to the anesthesiologist. In this study, we investigated the characteristic real-time ultrasonographic findings of the normal pediatric airway during tracheal intubation and its suitability for clinical use. METHODS: Thirty healthy children with normal airways requiring tracheal intubation were studied. Ultrasonographic measurements of the pediatric airway during tracheal intubation under deep inhaled anesthesia were performed using a Sonosite Titan (Sonosite, Bothell, WA) scanner while recording characteristic images during this process. Correct tracheal tube placement was further confirmed using auscultation and satisfactory end-tidal capnography. RESULTS: The mean (+/- sd) age of studied patients was 48 +/- 37 mo, weight was 19.7. +/- 8.6 kg and the sex ratio (m/f) was 1:2. Successful tracheal intubation was verified using the following criteria: 1) identification of the trachea and tracheal rings, 2) visualization of vocal cords, 3) widening of glottis as the tracheal tube passes through, and 4) tracheal tube position above carina and demonstration of movement of the chest wall visceroparietal pleural interface (i.e., sliding sign) after manual ventilation of the lungs. One esophageal intubation was readily recognized by visualization of the tube in the left paratracheal space. CONCLUSION: This study describes characteristic ultrasonographic findings of the pediatric airway during tracheal intubation. It suggests that ultrasonography may be useful for airway management in children. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19151273/Airway_management_in_children:_ultrasonography_assessment_of_tracheal_intubation_in_real_time L2 - http://dx.doi.org/10.1213/ane.0b013e31819240f5 DB - PRIME DP - Unbound Medicine ER -