Cross or Not to Cross-Dilemma of the Pulmonary Arteries.

We aimed to assess the frequency of criss-cross pulmonary arteries and associated intracardiac and vascular anomalies in patients who underwent CT angiography due to suspected congenital heart disease or vascular anomaly at our hospital. We retrospectively evaluated the CT angiography images of 355 patients aged 0-18 years between April 2018 and December 2022. The presence of the criss-cross pulmonary artery anomaly was assessed. Additionally, in patients with a criss-cross pulmonary artery anomaly, accompanying branch pulmonary artery anomalies, aortic arch anomalies, and other vascular-cardiac anomalies were also evaluated. A total of 331 patients' images were evaluated. Criss-cross pulmonary artery anomaly was present in 57 patients (17.2%). Pulmonary artery branch anomaly was present in 16, aortic arch anomaly in 40 patients (70%) with criss-cross pulmonary artery anomaly, while associated intracardiac pathology (by echocardiography) was detected in 43 patients (75.4%). The frequency of criss-cross pulmonary artery was found to be significantly higher in patients with any aortic arch anomaly (p = 0.01). This study represents one of the largest series of patients with criss-cross pulmonary artery anomalies. Our results suggests that it may be more common than previously recognized and potentially overlooked. It is crucial to consider the presence of this anomaly in patients with complex aortic arch anomalies or cardiac pathologies, as it may have implications for surgical approaches and potential complications. Increased awareness of this anomaly among cardiologists and radiologists is necessary for accurate diagnosis and appropriate management.

Role of ultrasonography in upper airway assessment: A comparison with computerized tomography measurements.

INTRODUCTION: This study aimed to compare ultrasonography (US) measurements of the upper airway to computerized tomography (CT) measurements. Our study's primary outcome is to research the accuracy of US measurements in the evaluation of upper airway diameters when CT is taken as the gold standard; the secondary outcome is to determine the time required to obtain US measurements. METHODS: This prospective study included patients ≥18 years old that had undergone thoracic or neck CT due to current clinical necessity. The US measurement for each patient was performed by two researchers with different levels of experience, both of whom were blinded to each other and the CT measurements. Measurements were obtained from the vocal cords and subglottic region. The duration of the US performance was also recorded. RESULTS: The US and CT measurements were obtained from 94 patients. Concordance between US and CT measurements was found in the Bland-Altman analysis, with a mean -0.05 mm difference for vocal cord diameter and -1.2 mm for subglottic diameter. The intra-class correlation coefficients (ICC) between the CT and US measurements were 0.993, and 0.609 for vocal cord and subglottic diameter measurements, respectively. The ICC between US performers was 0.992 for vocal cord diameter and 0.959 for subglottic diameter. The US's mean time for vocal cord diameter measurement was 38 ± 23 s, and the mean time for subglottic diameter measurement was 49 ± 30 s. CONCLUSION: The concordance between US and CT measurements is high and the measurements of different practitioners with different experience levels are compatible with each other.

Comparison of the effects PRICE and POLICE treatment protocols on ankle function in patients with ankle sprain.

BACKGROUND: Ankle sprain is a frequent reason for presentation to the emergency department. Current treatment modalities include Protection, Optimal Loading, Ice, Compression, and Elevation (POLICE) and Protection, Rest, Ice, Compression, and Elevation (PRICE). This study aimed to compare the effects of PRICE and POLICE treatment protocols. METHODS: This randomized controlled study was conducted between October 15, 2020, and October 15, 2021, at Ankara University's Department of Emergency Medicine. Double-blind randomization was used to assign patients to either the POLICE or PRICE treatment groups. RESULTS: In total, 109 patients were included. In the POLICE group, the median difference between the American Orthopedic Foot and Ankle Scores on admission and the 14th day following the injury was 34.5 (IQR: 27.25-41.75), while that of the PRICE group was 24 (IQR: 15.5-35). In the POLICE group, the median value of the difference in the Foot and Ankle Disability Index scores on admission and the 14th day following the injury was 42 (IQR: 35.25-50), while that of the PRICE group was 31 (IQR: 22-41.5). CONCLUSION: The POLICE treatment protocol provided more effective and faster recovery than the PRICE treatment protocol.

Numerical analysis and experimental verification of optical scattering from microplastics.

Accurate and fast characterization of the micron-sized plastic particles in aqueous media requires an in-depth understanding of light interaction with these particles. Due to the complexity of Mie scattering theory, the features of the scattered light have rarely been related to the physical properties of these tiny objects. To address this problem, we reveal the relation of the wavelength-dependent optical scattering patterns with the size and refractive index of the particles by numerically studying the angular scattering features. We subsequently present a low-cost setup to measure the optical scattering of the particles. Theoretical investigation shows that the angular distribution of the scattered light by microplastics carries distinct signatures of the particle size and the refractive index. The results can be used to develop a portable, low-cost setup to detect microplastics in water.

Rectus Sheath Hematoma in a Patient with Dual-Antiplatelet Therapy Including Ticagrelor: A Case Report.

Rectus sheath hematoma (RSH) is an uncommon cause of abdominal pain associated with several risk factors including trauma, asthma, chronic obstructive pulmonary disease, pregnancy, and anticoagulation as it can be iatrogenic. Dual-antiplatelet therapy (DAPT), combined usage of a P2Y12 receptor inhibitor and aspirin, is a cornerstone treatment for patients with acute coronary syndromes. Ticagrelor is a P2Y12 receptor inhibitor with several adverse hemorrhagic complications. An 86-year-old male patient was admitted to the emergency department with abdominal pain and a palpable abdominal mass at the left upper quadrant of the abdomen. His medical history revealed coronary artery disease with medications including acetylsalicylic acid and ticagrelor. Contrast-enhanced abdominal computed tomography revealed RSH. The patient was treated conservatively with bed rest and analgesia. DAPT is an essential component of the management of acute coronary syndromes to prevent recurrent cardiac thrombotic events. However, hemorrhagic complications such as RSH may be encountered with DAPT. Emergency medicine physicians and cardiologists should keep in mind RSH in patients presenting with abdominal pain and using DAPT with ticagrelor.

A Retrospective Analysis of Clinical Characteristics, Treatment Modalities and Outcome of the Patients With Infantile Hepatic Hemangiomas: Single-center Experience From Turkey.

OBJECTIVE: Hepatic hemangiomas (HH) are the most common vascular tumors of the liver. It is important to distinguish hemangiomas from malignant liver tumors. MATERIALS AND METHODS: The patients 0 to 1 years old, were diagnosed with HH and followed up in the oncology outpatient clinic between 2009 and 2020 were included in the study. RESULTS: A total of 127 patients with the diagnosis of HH were included in the study. Of the patients, 99 (78%) had focal, 20 (15.7%) had multifocal, and 8 (6.3%) had diffuse HHs. Surgery was performed and the diagnosis was confirmed histopathologically in 6 patients (4.7%). During the follow-up, 16 (12.5%) patients received medical treatment. Thirteen (10.2%) were treated with propranolol, 2 (1.5%) with corticosteroids, and 1 (0.8%) with propranolol and corticosteroids. Complete response was obtained in 9 (9/16) patients and partial response was obtained in 6 (6/16) patients with medical treatment. CONCLUSION: Although HH is a benign tumor, it is important to make its differential diagnosis with malignant tumors of the liver. Over the years, the need for histopathologic examination for diagnosis has decreased. The success rate of propranolol is high, and the need for other treatment options with a high side-effect profile has decreased significantly since 2008.

Evaluation of the Validity and Reliability of ANKUTRIAGE, a New Decision Support System in Pediatric Emergency Triage.

BACKGROUND: The intensity of emergency services is an increasing health problem all over the world, necessitating an effective triage system. The aim of this study was to evaluate the validity and reliability of the "ANKUTRIAGE" in children. METHODS: This prospective, longitudinal study was carried out at a pediatric emergency department. ANKUTRIAGE, a 5-level computer-aided triage decision support system, was developed. Patients younger than 18 years who do not need emergency intervention, who had complete vital sign measurements, who gave consent for the study, and who were admitted to the emergency service during working hours with trained personnel were included. For validity, agreement between the urgency levels determined by ANKUTRIAGE and the reference triage systems: Pediatric Canadian Triage and Acuity Scale and Emergency Severity Index, was evaluated. In addition, the association of urgency levels with clinical outcomes was studied. To assess reliability, patients were evaluated by 2 blinded healthcare professionals using ANKUTRIAGE and a quadratic weighted κ was estimated. RESULTS: A total of 1232 children with a median age of 4.00 years were included. ANKUTRIAGE acuity levels significantly correlated with the number of resources used, the number of patients undergoing life-saving procedures, pediatric intensive care unit, and overall hospitalization rates, respectively ( P < 0.001, P < 0.001, P < 0.001, P < 0.001). The agreement of ANKUTRIAGE with Pediatric Canadian Triage and Acuity Scale was found to be 0.94 (95% confidence interval [CI], 0.93-0.94), with an Emergency Severity Index of 0.75 (95% CI, 0.70-0.80). The interrater agreement between 2 evaluators who used ANKUTRIAGE reflected as excellent consistency 0.92 (95% CI, 0.89-0.95; κ > 0.8). CONCLUSIONS: ANKUTRIAGE demonstrated high agreement with clinical outcomes and with proven triage systems and reflected high reliability between users. ANKUTRIAGE will enable a more standardized and practical triage, especially in crowded pediatric emergency departments and in situations where triage is performed by health professionals with different experience and professions.

Pelvic Compression Device (Binder) Application Training in Medical Students: A Manikin Study.

BACKGROUND: Correct application of external pelvic compression devices (binders) is crucial in managing multitrauma patients with suspected pelvic fractures to control hemorrhage. Yet, there is a lack of practical training standards for pelvic compression device application in medical school education. OBJECTIVE: This study aimed to evaluate simulation training of pelvic compression device application by medical students to determine the number of applications required to meet proficiency measured by correct application and timeliness. METHODS: This is an observational cross-sectional measurement study of a convenience sample of 132 volunteer senior medical students who participated in a 30-min theoretical and simulation training session on the application of pelvic compression devices. The study was conducted between January 1, 2020, and March 1, 2020. Two weeks after the training, the students performed 10 consecutive pelvic compression device applications, each followed by a 5-min feedback session break. Application step accuracy and timing were observed and recorded. The percentage of correct applications was compared by χ2 test. RESULTS: The correct application rate for the first application was 42.4%, with an average of 92 s, 95% confidence interval (CI): 91.00-93.72. The highest correct application rate occurred in the eighth application (97%, p < .001), with an average application time of 87 s, 95% CI: 85.62-87.72. CONCLUSION: We found that at least eight pelvic compression device manikin applications were required to achieve proficiency.

Validation of the Turkish version of the second victim experience and Support Tool (T-SVEST).

Objectives: Second victim experience defines the healthcare professionals involved in unexpected adverse patient events. The Second Victim Experience and Support Tool (SVEST) is a tool used to measure the second victim experience and the desired support resources. This study aims to carry out a cross-cultural adaptation of the SVEST and to evaluate the psychometric properties of the Turkish version (T-SVEST). Methods: The T-SVEST was translated and adapted according to World Health Organization guidelines. 221 healthcare professionals including physicians, residents and nurses working at the emergency department, completed the survey. â€‹Cronbach's â€‹α â€‹values were assessed for reliability, and construct validity was assessed through confirmatory factor analysis in order to evaluate model fit. Results: The global Cronbach's α score of the T-SVEST was 0.90. The final version of the TSVEST including 24 items was consistent with values between 0.83 and 0.89. The most consistent dimension was turnover intentions with a Cronbach's value of 0.89, it was followed by institutional support (Cronbach α = 0.88). After applying modifications suggested by â€‹confirmatory factor analysis, a final model including 9 factor-structure (7 dimensions and 2 outcome variables) and 24 items was significantly improved with acceptable â€‹comparative fit index, â€‹Tucker-Lewis index â€‹and â€‹root mean square error of approximation. Conclusion: The Turkish version of the SVEST is a reliable and valid instrument that can be used to identify second victims and help implement support resources.

The acute motor axonal neuropathy variant of Guillain-Barré Syndrome diagnosed after ankle trauma.

A case of Guillain-Barré syndrome (GBS) was diagnosed in a patient admitted to the emergency department (ED) after ankle trauma was presented. GBS is generally defined as immune-mediated peripheral neuropathy that develops after an infection. Our patient presented to ED with ankle trauma that developed after fatigue. Lateral, medial, and posterior malleolar fractures were detected in the ankle. The patient with loss of motor strength in the distal muscles was diagnosed with acute motor axonal neuropathy variant of GBS. After GBS treatment, the patient's loss of muscle strength regressed, and then surgical treatment was performed. We aimed to present this case report, which emphasizes the systematic approach of the emergency physician without having a large differential diagnosis list.

Reliability and Validity of a New Computer-Based Triage Decision Support Tool: ANKUTRIAGE.

OBJECTIVE: Triage is a tool used to determine patients' severity of illness or injury within minutes of arrival. This study aims to assess the reliability and validity of a new computer-based triage decision support tool, ANKUTRIAGE, prospectively. METHODS: ANKUTRIAGE, a 5-level triage tool was established considering 2 major factors, patient's vital signs and characteristics of the admission complaint. Adult patients admitted to the ED between July and October, 2019 were consecutively and independently double triaged by 2 assessors using ANKUTRIAGE system. To measure inter-rater reliability, quadratic-weighted kappa coefficients (Kw) were calculated. For the validity, associations among urgency levels, resource use, and clinical outcomes were evaluated. RESULTS: The inter-rater reliability between users of ANKUTRIAGE was excellent with an agreement coefficient (Kw) greater than 0.8 in all compared groups. In the validity phase, hospitalization rate, intensive care unit admission and mortality rate decreased from level 1 to 5. Likewise, according to the urgency levels, resource use decreased significantly as the triage level decreased (P < 0.05). CONCLUSIONS: ANKUTRIAGE proved to be a valid and reliable tool in the emergency department. The results showed that displaying the key discriminator for each complaint to assist decision leads to a high inter-rater agreement with good correlation between urgency levels and clinical outcomes, as well as between urgency levels and resource consumptions.

Ultrasonographic determination of thyroid volume in infants and children from Aegean region of Turkey and comparison with national and international references.

OBJECTIVES: Accurate diagnosis and follow-up of pediatric patients with thyroid disorders, depends on the availability of appropriate data for normal thyroid volume (TV). The aim of this study was to determine the TV by ultrasonography (US) in subjects from the newborn period up to 18 years of age from the Aegean region of Turkey. METHODS: We measured the thyroid volumes in 513 children using US and compared them with the children's age, gender, standard deviation score (SDS) of body height (BH-SDS), body weight (BW-SDS), body mass index (BMI-SDS), and body surface area (BSA-SDS). The 3rd, 50th, and 97th percentiles of the age-dependent distribution of the TV were calculated and compared with national and international references. RESULTS: The BH, BW, BMI, and BSA of all the participants were within the normal ranges for Turkish children. The TV was significantly positively correlated with age, gender, BH-SDS, BW-SDS, BMI-SDS, and BSA-SDS in all subjects (r=0.748, r=0.267, r=0.730, r=0.735, r=0.664 and r=0.735, respectively; p<0.0001 for all). The most important predictors for TV were age and BW-SDS, followed by BSA-SDS and BH-SDS. In multivariate regression, age and BW-SDS were the only significant independent predictors for TV. Our results were nearly similar to the corresponding data reported by the World Health Organisation in 2004. CONCLUSIONS: The present study provides updated values for TV that can serve as a potential tool in differentiating the normal from the abnormal size of the thyroid gland in children aged 0-18 years from the Aegean region of Turkey.

Diaphragm dysfunction detected with ultrasound to predict noninvasive mechanical ventilation failure: A prospective cohort study.

OBJECTIVE: This study aimed to examine the use of point-of-care ultrasonography (POCUS) in detecting diaphragmatic dysfunction (DD) and evaluate its ability to predict noninvasive mechanical ventilation (NIV) failure in patients presented to the emergency department with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: In this prospective cohort study, the diaphragm was examined using POCUS in patients with AECOPD. DD was defined as a diaphragm thickening fraction of less than 20% during spontaneous breathing. NIV failure was the primary outcome of the study, and duration of hospital stay and in-hospital mortality were the secondary outcomes. Specificity, sensitivity, positive predictive value, and negative predictive value were estimated for predicting NIV failure in DD and evaluating the diagnostic performance of POCUS. RESULTS: 60 patients were enrolled the study. NIV failure was found in 11 (73.3%) of 15 patients with DD and in 2 (4.4%) of 45 patients without DD. In predicting NIV failure, DD had a sensitivity of 84.6% (95% confidence interval [CI]:54.6-98.1), specificity of 91.5% (95% CI:79.6-97.6), positive predictive value of 73.3% (95% CI:51.2-87.8), and negative predictive value of 95.6% (95% CI:85.7-98.7). The duration of hospital stay was not different between groups (p = .065). No in-hospital mortality was seen in patients without DD. CONCLUSIONS: DD has high sensitivity and specificity in predicting NIV failure in patients admitted to the emergency department with AECOPD. DD can be assessed by an experienced clinician noninvasively using POCUS in emergency departments.

Successful Management of l-Asparaginase-Associated Pancreatitis With Octreotide and Pegylated Asparaginase in 2 Patients With Acute Lymphoblastic Leukemia: Is There a Different Rare Warning Sign of Hypoglycemia for l-Asparaginase-Associated Pancreatitis?

l-Asparaginase (l-Asp) is a critical component of chemotherapy for acute lymphoblastic leukemia (ALL). However, toxic effects associated with l-Asp, such as hepatic dysfunction, pancreatitis, hypercholesterolemia, and hyperglycemia, have occurred. In addition, acute pancreatitis is a significant life-threatening adverse event associated with ALL. We describe 2 patients with ALL who had l-Asp-associated pancreatitis (AAP), with one patient presenting with hyperglycemia and the other presenting with hypoglycemia during induction treatment. When octreotide was administered to both of these patients, the clinical findings and laboratory data were improved. AAP was not repeated after treatment with pegylated asparaginase. Although AAP has a high risk of mortality and morbidity in childhood, APP treatment with appropriate agents, such as octreotide, can be successful.

Diagnostic Value of Bedside Lung Ultrasonography in Pneumonia.

Bedside lung ultrasonography (LUS) is a reliable method for the diagnosis of pneumonia. No common consensus exists in the literature regarding the effectiveness of LUS findings, except consolidation, for the diagnosis of pneumonia. The primary objective of this study was to investigate the effectiveness of LUS for the diagnosis of pneumonia, and the secondary objective was to investigate the use of LUS findings, except consolidation, for the diagnosis of pneumonia. A total of 127 patients with clinically suspected pneumonia were evaluated in the study. The sensitivity and specificity of LUS were 98.0% and 95.8%, respectively. In the cases where consolidation was not determined in LUS but B-3 line positivity or a diffuse interstitial pattern was present, the sensitivity and specificity were 93.3% and 88.2%, respectively. When consolidation was not observed in LUS, the presence of B-3 line positivity or diffuse interstitial pattern could be used for the diagnosis of pneumonia.

Mesenchymal stem cell transplantation in polytrauma: Evaluation of bone and liver healing response in an experimental rat model.

PURPOSE: Trauma is the most common cause of death of young people in the world. As known, mesenchymal stem cells (MSCs) accelerate tissue regeneration mechanisms. In our study, we aimed to investigate the effects of MSCs transplantation on the healing of liver and bone tissue by considering trauma secondary inflammatory responses. METHODS: 56 adult Wistar-albino rats were divided into two groups: the polytrauma (liver and bone) (n = 28), and the liver trauma group (n = 28). At 36 h and 5th day after surgery, both rats with polytrauma and with isolated liver injury received either intravenous (IV) or intraperitoneal (IP) injections of MSCs (one million cells per kg body weight). Untreated groups received IV and IP saline injections. At day 21 after surgery, liver, tibia and fibula of the subjects were excised and evaluated for histopathologic and histomorphometric examination. Additionally, whole blood count (white blood cells, hemoglobin and platelets), C-reactive protein (CRP), glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, blood gas, and trauma markers interleukin-1B (IL-1B), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF alpha) levels were investigated. RESULTS: In general, MSC transplantations were well tolerated by the subjects. It was found that ALT, CRP, albumin were significantly lower in rats which received MSCs (p < 0.001). Inflammation of the liver and bone tissue in the MSC-injected rats were significantly lower than that of the untreated groups. CONCLUSIONS: Herewith we have shown that MSC infusion in posttraumatic rats leads to less aggressive and more effective consequences on liver and bone tissue healing. Human MSC treatment for trauma is still in early stages of development; thus standard protocols, and patient inclusion criteria should be established beforehand clinical trials.

Hemopneumothorax After Trigger Point Injection for Fibromyalgia.

CONTEXT: Trigger point injections (TPIs) and acupuncture are common procedures in management of chronic back pain and usually are considered safe. Needling into cervical and thoracic regions can be associated with life-threatening complications. OBJECTIVE: The team intended to make practitioners aware of the potential for hemopneumothorax after TPI. DESIGN: The research team describes a case of hemopneumothorax after TPI. SETTING: The case study took place in the Department of Emergency Medicine at the Ankara University School of Medicine (Ankara, Turkey). PARTICIPANT: The participant was a 45-y-old woman, who had been admitted to the emergency department at the School of Medicine with dyspnea and dizziness after TPI for fibromyalgia. RESULTS: Computerized tomography of the thorax showed a significant hemopneumothorax at the right hemithorax and a collapsed right lung, markedly in the right, lower lobe. The hemopneumothorax was successfully treated with chest-tube and video-assisted thoracoscopic surgery. CONCLUSIONS: Health care professionals need to be aware of hemopneumothorax when performing TPI on the chest wall.

Transdermal Methanol Intoxication.

Methanol is a clear liquid with high toxicity. Methanol intoxication may result from accidental exposure, overconsumption of compounds containing methanol with suicidal intent, or following consumption of distilled and contaminated alcoholic beverages. This report describes a case of transdermal methanol intoxication, which is a rare condition. A 58-year-old woman presented with nausea, vomiting, weakness, diplopia and dizziness. On neurological examination, she only had diplopia. On physical examination, a hyperemic lesion with clear borders was found over the right knee. The patient's recent medical history revealed that four days prior to the onset of symptoms, she had covered her knee with a methanol-soaked bandage in an attempt to alleviate her knee pain. She had a high osmolar gap as well as high anion-gap metabolic acidosis (HAGMA). Methanol intoxication was suspected due to HAGMA and high osmolar gap. Serum methanol levels were subsequently measured and found to be 37.9 mg/ dL. The patient was treated with intravenous (IV) bicarbonate, IV ethyl alcohol and hemodialysis. She was discharged with no central nervous system or ophthalmologic sequelae. Methanol poisoning should be kept in mind in patients with diplopia and unexplained metabolic acidosis. Although most methanol intoxication cases occur after oral ingestion, it should be considered that methanol poisoning may occur transdermally.

Uso de la ecografía como una herramienta no invasiva decisiva para determinar el tamaño preciso del tubo endotraqueal en niños anestesiados / Use of ultrasonography as a noninvasive decisive tool to determine the accurate endotracheal tube size in anesthetized children

Introducción. Es difícil determinar el tamaño adecuado y la posición traqueal correcta del tubo endotraqueal (TET) en los niños. El objetivo de este estudio fue determinar el diámetro traqueal en los niños mediante el uso de la técnica ecográfica como herramienta objetiva y compararlo con fórmulas de uso frecuente basadas en la edad para calcular el tamaño del TET. Pacientes y métodos. Se inscribió de forma prospectiva a pacientes a los que se les iba a practicar una cirugía programada en un hospital pediátrico de alta complejidad. Se determinó el diámetro traqueal transversal infraglótico mediante ecografía. Un anestesista, que no podía ver el examen ecográfico, determinó el tamaño del tubo y realizó la intubación evaluando el espacio entre las cuerdas vocales con la ayuda de la vista directa de un laringoscopio. Se registraron los diámetros traqueales medidos con las ecografías, los diámetros de los tubos, los controles de presión/pérdida de aire y los resultados de los cálculos del tamaño de los tubos basados en la edad. Resultados. Se inscribieron en total 61 pacientes con una media de edad de 12 ± 4,21 (2-17) y un peso medio de 38 ± 22,94 (10-106). El diámetro de la tráquea en la medición ecográfica fue de 13.0 (11,4-15,1). El diámetro externo del TET determinado por el anestesista fue de 8,42 ± 1,43, el calculado por la fórmula de Cole fue de 9.0 ± 1,42, el calculado por la fórmula de Khine fue de 7,67 ± 1,46 y el calculado por la fórmula de Motoyama fue de 8,33 ± 1,42. En 31 (47,7%) pacientes, se insufló el manguito después de la colocación del TET debido a la pérdida de aire. El tubo tuvo que reemplazarse por uno más grande a causa de la pérdida excesiva de aire en un paciente. Se halló una correlación intraclase deficiente entre los cálculos del diámetro traqueal determinado por ecografía y los cálculos del diámetro del tubo basado en la edad (diámetro traqueal frente a Cole -amp;#91;0,273-amp;#93;, Khine -amp;#91;0,207-amp;#93; y Motoyama -amp;#91;0,230-amp;#93;). Conclusión. La medición ecográfica del diámetro traqueal transversal es un método adecuado para determinar el tamaño correcto del tubo endotraqueal en comparación con las fórmulas basadas en la edad.

Background. It is hard to determine the appropriate size and correct tracheal position of endotracheal tube (ETT) in children. The aim of this study is to determine tracheal diameter in children by using ultrasonography technique as objective tool and compare it with commonly used aged based formulas for the ETT size estimation. Patients and methods. Patients undergoing elective surgery in a tertiary children's hospital were prospectively enrolled. The subglottic transverse tracheal diameter was determined by ultrasonography. An anesthesiologist who was blind to ultrasonographic examination, determined the tube size and performed intubation by evaluating the space between vocal cords with the help of a direct laryngoscopic view. Ultrasonographically measured tracheal diameter, tube diameters, leak/pressure controls, and results of age-based tube size calculations were recorded. Results. A total of 61 patients, mean age of 12 ± 4.21 (217) years and mean weight of 38 ± 22.94 (10-106) kg were enrolled. The diameter of trachea measured by ultsonography was 13.0 (11.4-15.1). Outer diameter (mm) of the ETT determined by anesthesiologist was 8.42 ± 1.43; calculated by Cole formula was 9.0 ± 1,42; calculated by Khine formula was 7.67 ± 1.46; calculated by Motoyama formula was 8.33 ± 1.42. ETT cuff was inflated after ETT placement due to leak in 31 (47.7%) patients. Tube was replaced by a larger tube due to excessive leak in one patient. Poor intraclass correlation was found between ultrasonographically determined tracheal diameter and aged based tube diameter calculations (tracheal diameter vs Cole -amp;#91;0.273-amp;#93;, Khine -amp;#91;0.207-amp;#93;, and Motoyama -amp;#91;0.230-amp;#93;). Conclusion. Ultrasonographical determination of transverse tracheal diameter is a suitable method for determining the correct endotracheal tube size when compared with the age based formulas.

Use of ultrasonography as a noninvasive decisive tool to determine the accurate endotracheal tube size in anesthetized children. / Uso de la ecografía como una herramienta no invasiva decisiva para determinar el tamaño preciso del tubo endotraqueal en niños anestesiados.

BACKGROUND: It is hard to determine the appropriate size and correct tracheal position of endotracheal tube (ETT) in children. The aim of this study is to determine tracheal diameter in children by using ultrasonography technique as objective tool and compare it with commonly used aged based formulas for the ETT size estimation. PATIENTS AND METHODS: Patients undergoing elective surgery in a tertiary children's hospital were prospectively enrolled. The subglottic transverse tracheal diameter was determined by ultrasonography. An anesthesiologist who was blind to ultrasonographic examination, determined the tube size and performed intubation by evaluating the space between vocal cords with the help of a direct laryngoscopic view. Ultrasonographically measured tracheal diameter, tube diameters, leak/pressure controls, and results of age-based tube size calculations were recorded. RESULTS: A total of 61 patients, mean age of 12 ± 4.21 (2- 17) years and mean weight of 38 ± 22.94 (10-106) kg were enrolled. The diameter of trachea measured by ultsonography was 13.0 (11.4-15.1). Outer diameter (mm) of the ETT determined by anesthesiologist was 8.42 ± 1.43; calculated by Cole formula was 9.0 ± 1,42; calculated by Khine formula was 7.67 ± 1.46; calculated by Motoyama formula was 8.33 ± 1.42. ETT cuff was inflated after ETT placement due to leak in 31 (47.7%) patients. Tube was replaced by a larger tube due to excessive leak in one patient. Poor intraclass correlation was found between ultrasonographically determined tracheal diameter and aged based tube diameter calculations (tracheal diameter vs Cole [0.273], Khine [0.207], and Motoyama [0.230]). CONCLUSION: Ultrasonographical determination of transverse tracheal diameter is a suitable method for determining the correct endotracheal tube size when compared with the age based formulas.

Introducción. Es difícil determinar el tamaño adecuado y la posición traqueal correcta del tubo endotraqueal (TET) en los niños. El objetivo de este estudio fue determinar el diámetro traqueal en los niños mediante el uso de la técnica ecográfica como herramienta objetiva y compararlo con fórmulas de uso frecuente basadas en la edad para calcular el tamaño del TET. Pacientes y métodos. Se inscribió de forma prospectiva a pacientes a los que se les iba a practicar una cirugía programada en un hospital pediátrico de alta complejidad. Se determinó el diámetro traqueal transversal infraglótico mediante ecografía. Un anestesista, que no podía ver el examen ecográfico, determinó el tamaño del tubo y realizó la intubación evaluando el espacio entre las cuerdas vocales con la ayuda de la vista directa de un laringoscopio. Se registraron los diámetros traqueales medidos con las ecografías, los diámetros de los tubos, los controles de presión/ pérdida de aire y los resultados de los cálculos del tamaño de los tubos basados en la edad. Resultados. Se inscribieron en total 61 pacientes con una media de edad de 12 ± 4,21 (2-17) y un peso medio de 38 ± 22,94 (10-106). El diámetro de la tráquea en la medición ecográfica fue de 13,0 (11,4-15,1). El diámetro externo del TET determinado por el anestesista fue de 8,42 ± 1,43, el calculado por la fórmula de Cole fue de 9,0 ± 1,42, el calculado por la fórmula de Khine fue de 7,67 ± 1,46 y el calculado por la fórmula de Motoyama fue de 8,33 ± 1,42. En 31 (47,7%) pacientes, se insufló el manguito después de la colocación del TET debido a la pérdida de aire. El tubo tuvo que reemplazarse por uno más grande a causa de la pérdida excesiva de aire en un paciente. Se halló una correlación intraclase deficiente entre los cálculos del diámetro traqueal determinado por ecografía y los cálculos del diámetro del tubo basado en la edad (diámetro traqueal frente a Cole [0,273], Khine [0,207] y Motoyama [0,230]). Conclusión. La medición ecográfica del diámetro traqueal transversal es un método adecuado para determinar el tamaño correcto del tubo endotraqueal en comparación con las fórmulas basadas en la edad.