응급실에서 행해지는 소아 기관내삽관을 위한 적절한 깊이 추정 방법의 비교 연구
What is the Most Appropriste Method for Estimating the Depth for Endotracheal Tubes not to Pass through the Trachea of Korean Children in the Emergency Department?
조형래, 이정용, 김중헌, 이종승, 류정민,
소속 상세정보
조형래 ( Cho Hyung-Rae )
울산대학교 의과대학 서울아산병원 소아청소년병원 소아응급센터
이정용 ( Lee Jeong-Yong )
울산대학교 의과대학 서울아산병원 소아청소년병원 소아응급센터
김중헌 ( Kim Jung-Heon )
울산대학교 의과대학 서울아산병원 소아청소년병원 소아응급센터
이종승 ( Lee Jong-Seung )
울산대학교 의과대학 서울아산병원 소아청소년병원 소아응급센터
류정민 ( Ryu Jeong-Min )
울산대학교 의과대학 서울아산병원 소아청소년병원 소아응급센터
KMID : 1037620140010010017
Abstract
Purpose: The more younger the child, the more complications of endotracheal intubation are likely, such as deep intubation, extubation, atelectasis, or barotraumas, because of the small diameter and short length of the trachea. Therefore, the exact placement of tube tip in the middle third of trachea is very important; however, normal reference ranges of the length from incisors to middle third of the trachea for Korean children is not prepared yet.
Methods: A retrospective study was conducted on 48 children, who underwent endotracheal intubation in the emergency department of Asan Medical Center, between February 1997 and October 2007. After correcting the depth in actual tip positions by the difference between the actual intubation depths and calculated or measured depths by various methods, such as PALS guidelines, APLS formula, formula method, Broselow tape, and new formula, a comparison between these various methods was done.
Results: Most commonly, the tube position was too deep including position in the right main bronchus (71%). Among the children who underwent right main bronchus intubation, more than half were children less than 2 years of age (58%). The highest rate of appropriate tube position was observed when corrected using the PALS guideline (69%), and the lowest rate was observed in formula method (26%).
Conclusion: Meticulous intubation technique requires not to intubate too deep especially in young children less than 2 years of age. Physicians responsible for acute care of children should be knowledgeable of the PALS guideline for the appropriate depth of tracheal tube. However, it is also important to note the possibility of deep intubation while adhering to this guideline (approximately 40%). The development of methods or devices based on the distance from incisors to mid-portion of the trachea for Korean children is necessary.
키워드
Child; Intubation; Airway Management; Emergencies
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