Abstract
Proper endotracheal tube (ETT) size selection and identification of potentially difficult airways are important to reduce laryngeal injury during intubation. However, controversies exist concerning transverse subglottic diameter-the narrowest part of the airway-and the distance to pre-epiglottic space. Because few studies have reported the distance from skin to the midpoint of the epiglottis (DSE) among normal individuals, whether the DSE varies between individuals and by ethnicity remains uncertain. The present study aims to investigate the sonographic subglottic diameter and DSE among healthy Chinese adults. Healthy volunteers were recruited at National Taiwan University Hospital between October and November 2019. Exclusion criteria included pre-existing airway or respiratory diseases, neck tumors, and a history of neck operation. Age, sex, height, weight, body mass index (BMI), sonographic DSE, and transverse subglottic diameter were recorded. A total of 124 participants were enrolled. The average age was 32.5 ± 10.4 years and 63 participants (51%) were males. The subglottic diameter was positively associated with sex (males, 14.40 mm; females, 11.10 mm, p < 0.001) and BMI (underweight, 12.13 mm; normal weight, 12.47 mm; overweight, 13.80 mm; obese, 13.67 mm, p = 0.007). Moreover, the DSE was shorter in males (male, 16.18 mm; females, 14.54 mm, p < 0.001) and participants with increased BMI (underweight, 13.70 mm; normal weight, 15.06 mm; overweight, 16.58 mm; obese, 18.18 mm, p < 0.001). As compared with other ethnicity, a smaller size of subglottic diameter and a shorter DSE were noted among Chinese participants, and we suggest that a relatively smaller size of endotracheal tube selection should be considered in tracheal intubations.
Highlights
Airway management is essential in emergency and critical care settings
Oversized endotracheal tube (ETT) may cause complications such as pressure necrosis, tracheal stenosis, and obstruction [28,29,30], resulting in laryngeal injury when intubating with the current recommendations for ETT size
The results in this study provide the normal airway size using the transverse subglottic diameter, and they imply that ETTs for Chinese adults should be a smaller size than that the current recommendations, such as a size of 6.5 to 7 for females and 7.5 to 8 for males
Summary
Study design and participantsThis was a prospective, single-center, observational study, conducted at National Taiwan University Hospital (NTUH) between October and November 2019. The primary investigator was not involved in the recruitment process and had no prior knowledge of the recruitment method
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