小児の気管内チューブ挿入深さは、X線で観察された理想的な位置とよく一致しているか？

Does the endotracheal tube insertion depth predicted by formulas in children have a good concordance with the ideal position observed by X-ray?

• Dayanna Letícia Silva Santos
• Paulo Douglas de Oliveira Andrade
• Evelim Leal de Freitas Dantas Gomes

抄録

目的:

小児における気管内チューブの挿入深さを推定するためのさまざまな式の有効性を評価すること。

OBJECTIVE: To evaluate the effectiveness of the different formulas for estimating the insertion depth of an endotracheal tube in children.

方法:

小児集中治療室に入院し，機械的に人工呼吸を行った生後29日から2歳までの小児を対象とした観察的・横断的研究である。身長［（身長/10）＋5］，チューブ内径（気管内チューブ×3），体重（体重＋6）に基づく計算式を用いて，X線で評価した気管内チューブの理想的な挿入深さとどちらがより良い一致を示したかを評価した。

METHODS: This was an observational and cross-sectional study that included children between 29 days and 2 years of age who were hospitalized in a pediatric intensive care unit and mechanically ventilated. The formulas based on height [(height/10) + 5], the inner diameter of the tube (endotracheal tube × 3), and weight (weight + 6) were evaluated to determine which of them showed better concordance with the ideal insertion depth of the endotracheal tube as evaluated by X-ray.

結果:

高さに基づく計算とX線上で観察される理想的な深さとの相関は強く、r = 0.88、p < 0.05、コンコーダンス相関係数0.88、重量に基づく計算とX線上で観察される深さとの相関はr = 0.75、p < 0.05、コンコーダンス相関係数0.43、内気管チューブ径に基づく計算とX線上で観察される深さとの相関はr = 0.80、p < 0.05、コンコーダンス相関係数0.78であった。Linのコンコーダンス相関分析により、測定値は弱いコンコーダンスを示した（＜0.90）。

RESULTS: The correlation between the height-based calculation and the ideal depth observed on X-ray was strong, with r = 0.88, p < 0.05, and a concordance correlation coefficient of 0.88; the correlation between the weight-based calculation and depth on X-ray was r = 0.75, p < 0.05, and concordance correlation coefficient 0.43; and the correlation between endotracheal tube diameter-based calculation and depth on X-ray was r = 0.80, p < 0.05, and concordance correlation coefficient 0.78. Lin's concordance correlation analysis indicated that the measurements showed weak concordance (< 0.90).

結論:

小児の内気管チューブの挿入深さを推定する式は精度が低く、ゴールドスタンダードのX線評価法と不一致であった。挿管時に小児集中治療室の医療従事者を誘導するのに有効な、人間学的変数（体重と身長）と年齢に基づく新しい方法が必要とされている。

CONCLUSION: The formulas that estimate the insertion depth of the endotracheal tube in children were not accurate and were discordant with the gold-standard method of X-ray evaluation. There is a need for a new method based on anthropometric variables (weight and height) and age that is effective in guiding health professionals of pediatric intensive care units at the time of intubation.