Abstract
Objective
To validate the ERC-recommended facial landmark-distance for oropharyngeal airway
sizing in children.
Methods
We conducted a prospective observational study in anaesthetised, spontaneously breathing
children ≤12 years undergoing cranial MRI. Oropharyngeal airways were inserted following
the distance from the maxillary incisors to the mandibular angle. Primary outcome
was the rate of properly sized oropharyngeal airways on MRI, defined as the distal
end positioned within 10 mm from the epiglottis without contacting it. Secondary outcomes
were the occurrence of tongue protrusion, oropharyngeal airways clinical efficacy,
and related adverse events. Furthermore, we calculated probabilities for the estimation
of proper size when considering five facial landmark-distances and optimal rules based
on biometric parameters.
Results
In 94 children with a mean (SD) age of 4.7 (±3) years, 47.9% [95%-CI 38%-57.9%] oropharyngeal
airways were properly sized, while 23.4% [95%-CI 15.9%–33%] were undersized, and 28.7%
[95%-CI 20.5%-38.7%] oversized. Tongue protrusion occurred in 59.1% [95%-CI 38.2%-77.2%]
of undersized and 15.6% [95%-CI 7.6%-29.2%] of properly sized oropharyngeal airways.
No oropharyngeal airway required replacement. Comparing probabilities for five landmark-distances,
“maxillary incisors to the angle of the mandible” proved superior for proper sizing
at 41.2% [95%-CI 32%-51.7%]. The best-fit formula was “22.43 + 17.54 × log(weight[kg])” with a probability of 61.7% [95%-CI 51.5%-70.9%].
Conclusion
Although the facial landmark-distance “maxillary incisors to the angle of the mandible”
does not reliably predict oropharyngeal airway size, no clinical problems have been
encountered. Since it can be considered the least inaccurate facial landmark-distance,
it can serve as an approximation, but the efficacy of oropharyngeal airways should
be evaluated clinically.
Registered clinical trial: German Clinical Trials Register; DRKS00025918.
Keywords
Abbreviations:
ERC (European Resuscitation Council), MRI (magnetic resonance imaging), OPA (oropharyngeal airway)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 23, 2023
Accepted:
January 15,
2023
Received in revised form:
December 30,
2022
Received:
October 31,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
