Abstract
Introduction
Sonography has gained a broad field of applications in current anesthetic practice. During airway management, it could have an important role, because it allows real-time measurement of anatomical aspects and a functional evaluation with high safety profile. However, assessment of the reliability and precision of these measurements is critical if sonography is used as a clinical diagnostic tool. The aim of the study was to estimate inter-rater and intra-rater reliability of the airway diameter measured by sonography in heathy volunteers.
Methods
We conducted a cross-sectional study during 2015 on healthy adult volunteers. Using sonography, transverse internal diameter of subglottic space was measured twice by two blinded sonographers.
Results
Agreement was classified as very good for intra-rater measurements (ICC = 0.84) and good for the inter-rater measurements (ICC = 0.71). The 95% CI of agreement limits for the intra-rater measurements were inferior to those for the inter-rater measurements.
Conclusions
Ultrasound measurement is a reliable and precise method to measure the internal subglottic diameter of the airway. Ultimately, this method may provide clinicians valuable information regarding airway diameter in adults and may help to guide treatment options.
Sommario
Scopo
L’ecografia ha acquisito nel tempo un ruolo importante in diverse applicazioni nella pratica anestesiologica corrente. Durante la gestione delle vie aeree, potrebbe avere un ruolo importante in quanto consente di misurare in tempo reale gli aspetti anatomici e una valutazione funzionale con un elevato profilo di sicurezza. Tuttavia, la valutazione dell’affidabilità e della precisione di queste misurazioni è fondamentale se l’ecografia viene utilizzata come strumento diagnostico clinico. Lo scopo di questo studio è di stimare l’affidabilità inter e intra-osservatore del diametro delle vie aeree misurate ecograficamente su volontari sani.
Metodi
Nel corso del 2015 abbiamo condotto uno studio trasversale su volontari adulti sani. Utilizzando l’ecografia, il diametro interno trasversale dello spazio subglottico è stato misurato due volte da due ecografisti in doppio cieco.
Risultati
L’accordo inter e intra-osservatore è stato classificato rispettivamente come buono (CCI = 0.71) e molto buono (CCI = 0.84). I limiti della misura di concordanza intra-osservatore con IC del 95% erano inferiori rispetto a quelli inter-osservatore.
Conclusioni
La misura dello spazio subglottico con l’ecografia è un metodo affidabile e preciso per misurare il diametro subglottico interno della via aerea. In definitiva, questo metodo può fornire ai medici informazioni preziose riguardo il diametro delle vie aeree negli adulti e può aiutare a guidare le opzioni di trattamento.
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References
Wanderer JP, Rathmell JP (2015) Anesthesiologists and ultrasonography: a historical window. Anesthesiology 123(3):A23
Pita Fernández S, Pértega Díaz S, Rodríguez Maseda E (2003) La fiabilidad de las mediciones clínicas. El análisis de concordancia para variables numéricas. Cuadernos de atención primaria 10(4):290–296
Cortés-Reyes E, Rubio-Romero JA, Gaitán-Duarte H (2010) Métodos estadísticos de evaluación de la concordancia y la reproducibilidad de pruebas diagnósticas. Rev Colomb Obstet Ginecol 61(3):247–255
Schramm C, Knop J, Jensen K, Plaschke K (2012) Role of ultrasound compared to age-related formulas for uncuffed endotracheal intubation in a pediatric population. Paediatr Anaesth 22(8):781–786
Kim EJ, Kim SY, Kim WO, Kim H, Kil HK (2013) Ultrasound measurement of subglottic diameter and an empirical formula for proper endotracheal tube fitting in children. Acta Anaesthesiol Scand 57(9):1124–1130
Shibasaki M, Nakajima Y, Shimizu F, Shime N (2010) Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology 113:819–824
Lakhal K, Delplace X, Cottier J-P, Tranquart F, Sauvagnac X, Mercier C et al (2007) The feasibility of ultrasound to assess subglottic diameter. Anesth Analg 104(3):611–614
Lee S, Lee J, Kim T et al (2011) The relationship between the predictors of obstructive sleep apnea and difficult intubation. Korean J Anesthesiol 60(3):173–178
Kottner J, Audigé L, Brorson S, Donner A, Gajewski BJ et al (2011) Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol 64(1):96–106
Eliasziw M, Young SL, Woodbury MG, Fryday-Field K (1994) Statistical methodology for the concurrent assessment of interrater and intra-rater reliability: using goniometric measurements as an example. Phys Ther 74:777–788
Shrout PE, Fleiss J (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428
Barnhart HX, Haber MJ, Lin LI (2007) An overview on assessing agreement with continuous measurements. J Biopharm Stat 17(4):529–569
Bland JM, Altman DG (2003) Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol 22(1):85–93
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310
Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160
Team RC. R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2013. ISBN:3-900051-07-0; 2014
Griscom NT, Wohl ME (1985) Dimensions of the growing trachea related to body height. Length anteroposterior and transverse diameters, cross-sectional area and volume in subjects younger than 20 years of age. Am Rev Respir Dis 131(6):840–844
Karmakar A, Pate MB, Solowski NL, Postma GN, Weinberger PM (2015) Tracheal size variability is associated with sex: implications for endotracheal tube selection. Ann Otol Rhinol Laryngol 124(2):132–136
Childs JT, Esterman AJ, Thoirs KA (2014) Ultrasound measurements of the liver: an intra and inter-rater reliability study. Aust J Ultrasound Med 17:113–119
Eri LM, Thomassen H, Brennhovd B, Håheim LL (2002) Accuracy and repeatability of prostate volume measurements by trans-rectal ultrasound. Prostate Cancer Prostatic Dis 5(4):273–278
Saul T, Lewiss RE, Langsfeld A, Radeos MS, Del Rios M (2012) Inter-rater reliability of sonographic measurements of the inferior vena cava. J Emerg Med 42(5):600–605
Akkaya A, Yesilaras M, Aksay E, Sever M, Atilla OD (2013) The interrater reliability of ultrasound imaging of the inferior vena cava performed by emergency residents. Am J Emerg Med 31(10):1509–1511
Schwab RJ, Gefter WB, Pack AI, Hoffman EA (1993) Dynamic imaging of the upper airway during respiration in normal subjects. J Appl Physiol 74(4):1504–1514
Bolder PM, Healy TEJ, Bolder AR, Beatty PCW, Kay B (1986) The extra work of breathing through adult endotracheal tubes. Anesth Analg 65(8):853–859
Plummer AL, Gracey DR (1989) Consensus conference on artificial airways in patients receiving mechanical ventilation. CHEST J 96(1):178–180
Shapiro M, Wilson RK, Casar G, Bloom K, Teague RB (1986) Work of breathing through different sized endotracheal tubes. Crit Care Med 14(12):1028–1031
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All procedures performed in this study were in accordance with the ethical standards of The Institutional Research Committee and with the 1964 Helsinki declaration and its later amendments.
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Gómez-Tamayo, J.C., Puerta-Guarín, J.I., Rojas-Camejo, C.M. et al. Inter-rater and intra-rater reliability of the airway diameter measured by sonography. J Ultrasound 21, 35–40 (2018). https://doi.org/10.1007/s40477-017-0276-z
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DOI: https://doi.org/10.1007/s40477-017-0276-z