title: Airway management in children: ultrasonography assessment of tracheal intubation in real time?
abstract: BACKGROUND
  Pediatric tracheal intubation requires considerable expertise and can represent a challenge to many anesthesiologists. Confirmation of correct tracheal tube position relies on direct visualization or indirect measures, such as auscultation and capnography. These methods have varying sensitivity and specificity, especially in the infant and young child. Ultrasonography is noninvasive and is becoming more readily available to the anesthesiologist. In this study, we investigated the characteristic real-time ultrasonographic findings of the normal pediatric airway during tracheal intubation and its suitability for clinical use.
  
  
  METHODS
  Thirty healthy children with normal airways requiring tracheal intubation were studied. Ultrasonographic measurements of the pediatric airway during tracheal intubation under deep inhaled anesthesia were performed using a Sonosite Titan (Sonosite, Bothell, WA) scanner while recording characteristic images during this process. Correct tracheal tube placement was further confirmed using auscultation and satisfactory end-tidal capnography.
  
  
  RESULTS
  The mean (+/- sd) age of studied patients was 48 +/- 37 mo, weight was 19.7. +/- 8.6 kg and the sex ratio (m/f) was 1:2. Successful tracheal intubation was verified using the following criteria: 1) identification of the trachea and tracheal rings, 2) visualization of vocal cords, 3) widening of glottis as the tracheal tube passes through, and 4) tracheal tube position above carina and demonstration of movement of the chest wall visceroparietal pleural interface (i.e., sliding sign) after manual ventilation of the lungs. One esophageal intubation was readily recognized by visualization of the tube in the left paratracheal space.
  
  
  CONCLUSIONS
  This study describes characteristic ultrasonographic findings of the pediatric airway during tracheal intubation. It suggests that ultrasonography may be useful for airway management in children.
authors.affiliation: Pôle d'Anesthésie Réanimation, Hôpital Jeanne de Flandre, CHRU, Rue Eugène Aviné, 59037 Lille Cedex France. bmarciniak@chru-lille.fr
authors.forename: Bruno
authors.initials: B
authors.lastname: Marciniak
authors.forename: Pierre
authors.initials: P
authors.lastname: Fayoux
authors.forename: Anne
authors.initials: A
authors.lastname: Hébrard
authors.forename: Renée
authors.initials: R
authors.lastname: Krivosic-Horber
authors.forename: Thomas
authors.initials: T
authors.lastname: Engelhardt
authors.forename: Bruno
authors.initials: B
authors.lastname: Bissonnette
mesh_terms: D000769:Anesthesia, Inhalation; D001314:Auscultation; D019296:Capnography; D002648:Child; D002675:Child, Preschool; D003199:Computer Systems; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D005931:Glottis / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D014132:Trachea / Q000000981:diagnostic imaging*; D014463:Ultrasonography