Preditores clínicos de laringoscopia difícil em pediatria
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Data
2013-02-20
Autores
Mansano, André Marques [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O manejo correto das vias aéreas em pacientes pediátricos é fundamental da prática anestésica, em ambientes de terapia intensiva ou unidades de emergência. Avaliar preditores clínicos de laringoscopia difícil em pacientes pediátricos, bem como mensurar a eficácia da manipulação laríngea externa otimizada em melhor a visualização da glote durante a laringoscopia. 445 crianças abaixo de 12 anos foram avaliadas, de modo transversal, quanto à presença de características antropométricas relacionadas à laringoscopia difícil. Os pacientes foram divididos em três grupos de acordo com a idade. Peso, altura, circunferência do pescoço, distância interincisivos (DII), distância tireomentoniana, distância esternomentoniana, distância entre o plano frontal e o mento (DPFM) e a classificação de Mallampati modificada foram determinados e correlacionados com a classificação de Cormack e Lehane (CML). A incidência de laringoscopia difícil (CML III ou IV) foi de 11,23%, reduzindo para 3,59% após a manipulação laríngea externa otimizada. Os fatores que estiveram relacionados com dificuldade de laringoscopia difícil foram: distância interincisivos diminuída, DPFM aumentada, distância tireomentoniana ou esternomentoniana diminuídas ou a classificação de Mallampati modificada III ou IV. O índice entre a DPFM e o peso obteve a maior área sob a curva ROC entre as variáveis estudadas. A DPFM e o índice DPFM/peso são os melhores preditores de laringoscopia difícil em crianças. A distância interincisivos também está correlacionada com a laringoscopia difícil. Em pacientes capazes de obedecer ordens simples, o índice de Mallampati modificado também apresentou boa correlação com laringoscopia difícil, embora não possa ser utilizado de forma isolada...
Pediatric airway management is a priority during anesthesia, critical care and emergency medicine. The purpose of this study is to validate bedside tests that predict laryngoscopic difficulty in anesthetized children and to measure improvement in laryngoscopic view by optimal external laryngeal manipulation. 445 children under 12 years of age were recruited in a cross-sectional study to assess the value of some anthropometric measures as predictors of laryngoscopic difficulty. The patients were divided into three groups by age. Weight, height, neck circumference, interincisor distance (IID), short thyromental distance, sternomental distance, frontal plane to chin distance (FPCD) and the modified Mallampati index were determined and were correlated with the Cormack and Lehane classification (CML). The incidence of difficult laryngoscopy (CML III or IV) was 11.23%, been reduced to 3.59% after optimal external laryngeal manipulation. Factors that were significantly associated with laryngoscopic difficulty included short IID, thyromental distance or sternomental distance, high FPCD, and the modified Mallampati index III and IV. The FPCD/weight index exhibited a higher area under the ROC curve than any other variable considered. This study confirms that the FPCD and the FPCD/weight ratio are the most consistent predictors of laryngoscopic difficulty in pediatric patients. The IID also correlated with laryngoscopic difficulty. For children who... (Complete abstract click electronic access below)
Pediatric airway management is a priority during anesthesia, critical care and emergency medicine. The purpose of this study is to validate bedside tests that predict laryngoscopic difficulty in anesthetized children and to measure improvement in laryngoscopic view by optimal external laryngeal manipulation. 445 children under 12 years of age were recruited in a cross-sectional study to assess the value of some anthropometric measures as predictors of laryngoscopic difficulty. The patients were divided into three groups by age. Weight, height, neck circumference, interincisor distance (IID), short thyromental distance, sternomental distance, frontal plane to chin distance (FPCD) and the modified Mallampati index were determined and were correlated with the Cormack and Lehane classification (CML). The incidence of difficult laryngoscopy (CML III or IV) was 11.23%, been reduced to 3.59% after optimal external laryngeal manipulation. Factors that were significantly associated with laryngoscopic difficulty included short IID, thyromental distance or sternomental distance, high FPCD, and the modified Mallampati index III and IV. The FPCD/weight index exhibited a higher area under the ROC curve than any other variable considered. This study confirms that the FPCD and the FPCD/weight ratio are the most consistent predictors of laryngoscopic difficulty in pediatric patients. The IID also correlated with laryngoscopic difficulty. For children who... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Crianças, Pediatria, Laringoscopia, Laringe - Doenças - Diagnóstico, Laryngoscopy
Como citar
MANSANO, André Marques. Preditores clínicos de laringoscopia difícil em pediatria. 2013. 96 f. Tese (doutorado) - Universidade Estadual Paulista Julio de Mesquita Filho, Faculdade de Medicina e Botucatu, 2013.