Estimation of the optimum length of endotracheal tube insertion in adults

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"etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anesthesiologist, Universidad de Caldas, Manizales, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Third Year Anesthesiology Resident, Universidad de Caldas, Manizales, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: calle 68ª N° 9-100, casa 23, conjunto residencial Rincón de la Palma, Manizales, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estimación de la longitud óptima de inserción del tubo orotraqueal en adultos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:9 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1467 "Ancho" => 2427 "Tamanyo" => 118508 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Distances measured by fiberoptic bronchoscope. M: distance from the proximal edge of the adaptor of the endotracheal tube to the right angle of the mouth. C: distance from the proximal edge of the endotracheal tube adapter to the carina." ] ] ] "textoCompleto" => "IntroductionThe incorrect placement of an endotracheal tube can lead to serious complications including endobronchial intubation, vocal cord paralysis, accidental extubation, collapsed lung, hypoxemia, and pulmonary barotrauma, among others.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a> Endobronchial intubation is the most common critical incident that can cause arterial desaturation during orotracheal intubation. According to the ASA Closed Claims Project, selective intubation accounts for 2% of adverse respiratory events in adults,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> and considering the more serious or fatal consequences of these events, including cerebral damage in up to 85% of patients,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> the correct placement of the tip of the endotracheal tube is a vital element in the practice of anesthesiology and emergency and critical care medicine.There are many methods to check the placement of the endotracheal tube, including the clinical method (auscultation of respiratory sounds, observation of the symmetry of chest expansion), palpation techniques (palpation of the endotracheal cuff in the suprasternal notch), imaging methods, capnography, direct visualization of the tip of the tube in relation to the carina using a fiberoptic bronchoscope<a class="elsevierStyleCrossRef" href="#bib0005">1</a> and ultrasound,<a class="elsevierStyleCrossRef" href="#bib0025">5</a> by either visualizing the tube directly in the airway or corroborating bilateral pleural sliding using a linear probe. However, these methods are not always based on evidence, nor are they always cost effective or applicable to every scenario of a given situation.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Some authors have found that in 28% of patients with cardiac arrest, intubated by staff trained in advanced life support, the tip of the tube was endobronchial.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> Using the traditional insertion method of the endotracheal tube of 21 and 23cm in women and men respectively as proposed in the literature several years ago,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> some publications show figures of more than 33.4% of endotracheal tubes incorrectly placed,<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> this being a more frequent adverse event in women than in men (61.9% vs 38.1%).<a class="elsevierStyleCrossRef" href="#bib0010">2</a> This gap is not considered ideal and is a big unknown when referring to populations with different anatomical proportions to those used in the initial study.These considerations then raise the question: in adult patients requiring orotracheal intubation for whatever reason, what is the optimal distance for endotracheal tube insertion?After an exhaustive search of all available electronic databases (Medline, Embase and Virtual Health Library), no literature was found that dealt with Latin American or Colombian populations.Based on this, the objective of this study was to determine the length of optimum insertion of the endotracheal tube based on height for patients undergoing surgical procedures using intubation in two local tertiary hospitals.Materials and methodsA cross-sectional study was conducted with a total population of 516 adults of both sexes, between the ages of 18 and 90, undergoing surgery in the Santa Sofia and SES Hospitals in Caldas, Colombia, between September 2011 and February 2015, classified as ASA I or II, and requiring orotracheal intubation during the procedure.The minimum sample size (359 patients) was determined with the variance obtained from the height (69.4) from an estimated population of 1800 patients intubated per year in the operating rooms of Santa Sofia Hospital and 1500 patients in the SES Hospital of Caldas.The criteria of exclusion were patients with hemodynamic instability, decompensated cardiorespiratory disease, and anatomical changes to the face, cervical region and upper airway.The variables studied were simple and grouped by age (under and over the age of 60), sex, height, distance from the proximal edge of the endotracheal tube adaptor to the right angle of the mouth (M), distance from the proximal edge of the tube adaptor to the carina (C) and mouth-carina distance (C–M).Techniques and proceduresPrevious authorization from the bioethics committees of the University of Caldas, the Santa Sofía Hospital and SES Hospital of Caldas was obtained in accordance with the Helsinki declaration, as well as authorization from each patient by signed, informed consent. Before admission to surgery, data was obtained from the preanesthetic evaluation form to record height, age and sex. In the cases where no height was registered, this was taken by researchers using a height rod with a sensitivity of 1mm and 190cm in length.The data was obtained from patients who were undergoing general anesthesia in supine position, with the head in neutral position, and monitored using pulse oximetry, capnography, non-invasive blood pressure and electrocardiogram (ECG) with three leads. Each anesthesiologist selected the intubation technique as well as the size of the endotracheal tube and insertion length.Once the patient was intubated with the endotracheal tube secured to the right labial commissure at a distance considered appropriate by the anesthesiologist, an OLYMPUS LB-GP fiberoptic bronchoscope of dm 4.1mm was inserted through a double lumen tube adaptor to prevent anesthetic circuit disconnection. The distances obtained during the procedure using direct vision of the anatomical structures were the following (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Later, each distance marked on the fiberoptic bronchoscopy was measured using a metallic measuring tape with a sensitivity of one millimeter (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The distance obtained from the proximal edge of the tube to the carina (C) was measured and subtracted from the labial commissure, corresponding to the protruding portion of the mouth tube (M), which is how the carina-mouth distance (C–M) was finally determined.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Data analysis and softwareAll primary data was recorded on an instrument designed in Excel and was submitted to a preliminary pilot test for evaluation by experts, who considered the instrument to be adequate and sufficiently clear to collect the necessary data for the study. The statistical analysis was done using SPPS software v 15.0, licensed to the University of Caldas.The qualitative variable was described using absolute and relative frequency. The quantitative variables were described with the average, confidence interval of 95%, standard deviation, mean, 5 and 95 percentiles and minimum and maximum values. For the prediction of the mouth-carina distance from the height of the patient, a Pearson correlation analysis was conducted after proving the normality of the dependent variable with the Kolmogorov Smirnov test. After this, various linear regression equations for sex and age group were estimated. The results are presented in tables according to the characteristics of the variables.Results516 adults were studied between the ages of 18 and 90. Most of the population was under the age of 60 (71.3%) and a little over half (55.2%) were female.The results of the study showed that in 41.1% of men and 14% of women the mouth-carina distance was under 23 and 21cm, respectively. In <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, a description of the quantitative variables of the studied population is provided.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>After disaggregating the population data by sex and doing a mouth-carina distance analysis to confirm the normality of the variable, the average mouth-carina distance for men was 23.5cm, and 22.4cm for women. For both sexes the differences between the median and the mean were minimal.After doing a linear correlation analysis between the mouth distance variables and height, a direct and statistically significant correlation was found in all cases, for men and women both over and under the age of 60. The highest determination coefficient was for the population equal to or above 60 years of age.Without controlling for age, and grouping the population by sex and using height as the independent variable, the following linear regression models were obtained (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) along with their respective prediction equations (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>3cm was subtracted from each of the equations obtained. This corresponds, according to the literature, to the distance that the tube should remain from the carina.<a class="elsevierStyleCrossRefs" href="#bib0040">8,11</a>The mouth-carina distance estimated with the prediction equations, without discriminating based on age (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), and taking into account the median height for Colombian men (167cm) and for women (155cm) according to the National Survey of Nutritional Situation in Colombia (Encuesta Nacional de la Situación Nutricional de Colombia, ENSIN 2010), was as follows.Men: Mouth-carina distance=20.4cmWomen: Mouth-carina distance=19.2cmDiscussionThe findings of this study are coherent with those published by other researchers in different contexts and with different populations,<a class="elsevierStyleCrossRefs" href="#bib0005">1,7,12–14</a> with regard to the controversy about the appropriate endotracheal tube insertion length for women and men, respectively. Were we to take these measures as a reference in our study, the tube would be endobronchial in 41.1% of men and in 14.1% of women. However, if the equations estimated in this study are considered, endobronchial intubation would be reduced to 2.6% and 5% in men and women, respectively.Several studies exist of populations of different ethnic origin that relate the length of the airway with height. In 2002, in the Taiwanese population, the length of the airway from the mouth to the carina and its relationship with height was evaluated in 293 patients via fiberoptic bronchoscopy, obtaining a linear regression equation as a result: [height (cm)/5]−13.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Applying this equation to a Colombian woman with an average height of 155cm, the optimal insertion length of the tube should be left at 18cm. If the same exercise were done, but this time with the equation proposed in this study, the length would be 19.2cm, representing a variation of 1.2cm between the models.In another study performed in Thailand in 2005 with a population of 100 patients, the Chula formula [4+(height (cm)/10)] was used to determine the insertion length of the endotracheal tube, which, according to the conclusions, was successful in 99% of patients, insuring that the end of the tube remained at least 2cm above the carina, and that the upper edge of the endotracheal cuff remained at least 2cm below the vocal cords.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> When the equations are compared (the Chula formula and the equation from this study) with a 155cm tall woman, the difference in the optimal insertion length of the tube would be 0.3cm.In India in 2011, a study was carried out with 200 patients, concluding when the endotracheal tube is positioned at between 21 and 23cm, the end may come in contact with the carina or become endobronchial. As such, they proposed the following equation for determining the insertion length of the endotracheal tube: [height (cm)/7]−2.5.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> If we again consider a 155cm tall female patient, the difference in the insertion length when comparing this equation with the proposed equation, would be 0.4cm longer in the patients from India.The three studies mentioned above were developed with non-Latin American populations,<a class="elsevierStyleCrossRefs" href="#bib0030">6,8,14</a> which may in part explain the difference in their results and those obtained here.Contrary to what this study reports, some authors have found little correlation between height and airway length,<a class="elsevierStyleCrossRefs" href="#bib0035">7,13,15</a> arguing that this measure correlates between with external topographic measurements such as the distance from the corner of the mouth to the sternal manubrium,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> the distance from the upper incisors to the sternum,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> the distance from the cricoid cartilage to the xiphoid process, the sternal length, the length of the phalanges, the length of the ulna, and length of the foot,<a class="elsevierStyleCrossRef" href="#bib0065">13</a> among others. Nevertheless, the difficulty of obtaining these measurements in emergency situations limits their usefulness and could increase the risk for the patient.In agreement with other reports from the literature, the results of this study did not show differences related to sex in relation with the length of the airway<a class="elsevierStyleCrossRef" href="#bib0030">6</a>: if a man and a woman of equal heights are considered, and the formulas obtained in this study are applied, the mouth-carina distance is minimum. Therefore, it would not be appropriate to propose an optimal endotracheal tube insertion length based exclusively on the sex of the patient, since the height ranges are wide in both men and women.The limitation of this study lies in the fact that the sample of men and women was not selected at random. The patients included represent those scheduled for surgery during the time assigned for data collection.ConclusionThe traditional method of determining the endotracheal tube insertion length as 21cm for women and 23cm for men shows a high incidence of endobrachial intubations. The results of this study present a statistically significant correlation between height and mouth-carina distance. Therefore, the proposed equations based on height dependably predict the optimal endotracheal tube insertion length.RecomendationsThe authors propose the used of <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>, developed with heights for each sex, in which the optimal insertion length of the endotracheal tube is approximated in accordance with the prediction equations obtained in this study. Validating these values in later studies is proposed. Ideally, the above should be complemented with other strategies, such as auscultation, the direct viewing of the endotracheal tube balloon in its passage through the vocal cords, or thorax radiography.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Ethical disclosuresProtection of human and animal subjectsThe authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.FinancingThe present study was partially financed by the University of Caldas through recurring resources paid to the main researcher for teaching work and by contributions from Colciencias as support for the young researchers Drs. Lina Paola Melo and Yuliana Orozco as postgraduate residents during the initial phases of this project.Conflicts of interestThe authors declare having no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres679477" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec685433" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres679478" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec685432" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Techniques and procedures" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Data analysis and software" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Recomendations" ] 10 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0045" "titulo" => "Financing" ] 12 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-02-09" "fechaAceptado" => "2016-05-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec685433" "palabras" => array:5 [ 0 => "Bronchoscopy" 1 => "Intubation" 2 => "Airway management" 3 => "Adult" 4 => "Intraoperative complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec685432" "palabras" => array:5 [ 0 => "Broncoscopía" 1 => "Intubación" 2 => "Manejo de la vía aérea" 3 => "Adulto" 4 => "Complicaciones intraoperatorias" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionAn accurate estimation of the optimal length of endotracheal tube insertion can prevent complications such as endobronchial intubation, airway trauma and accidental extubation, all of which have a negative impact on patient safety and are associated with an increase in both morbidity and mortality. ObjectiveTo determine the optimal insertion length of endotracheal tubes in female and male adults according to their height. Materials and MethodsA cross-sectional analytical study conducted with 516 adult ASA I-II female and male patients who had different surgical procedures requiring endotracheal intubation. The mouth-carina distance was obtained using a flexible fiberoptic bronchoscope. The data analysis was performed using the SPSS 15.0 software. ResultsHeight and mouth-carina distance showed a direct and statistically significant correlation. Two equations for estimating optimal endotracheal insertion length were obtained, according to sex: men=11.413+(0.072×height in cm)−3; and women=13.555+(0.056×height in cm)−3. ConclusionThe traditional method of determining the insertion length of the endotracheal tube, 21cm for women and 23cm for men, shows a high incidence of endobronchial intubations in the analyzed population. The optimal insertion depth of the endotracheal tube can be reliably estimated through the use of prediction equations based on patient height, as proposed in this study." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónUna correcta estimación de la longitud óptima de inserción del tubo orotraqueal puede prevenir complicaciones como: intubación endobronquial, trauma de la vía aérea y extubación accidental, las cuales inciden de manera negativa en la seguridad del paciente y se asocian con aumento en la morbimortalidad. ObjetivoDeterminar la longitud de inserción óptima del tubo orotraqueal a partir de la talla en pacientes adultos de ambos sexos. Materiales y métodosEstudio analítico de corte transversal en 516 pacientes adultos de ambos sexos, ASA I o II, intervenidos quirúrgicamente, quienes requirieron intubación orotraqueal durante su procedimiento. La distancia boca-carina fue obtenida con la ayuda de un fibrobroncoscopio. El análisis de datos se efectuó con el software SPSS 15.0. ResultadosLa talla y la distancia boca-carina mostraron una correlación directa y estadísticamente significativa. Se obtuvieron dos ecuaciones para estimar la longitud de inserción óptima del tubo orotraqueal discriminadas según el sexo: hombres=11,413+(0,072 x talla en cm) - 3; mujeres=13,555+(0,056 x talla en cm) - 3. ConclusiónEl método tradicional para establecer la longitud de inserción del tubo orotraqueal de 21cm para mujeres y de 23cm para hombres, muestra una alta incidencia de intubaciones endobronquiales en la población estudiada. La longitud de inserción óptima del tubo orotraqueal se puede determinar de forma segura a partir de las ecuaciones de predicción, basadas en la talla, propuestas en este estudio." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Gómez JC, Melo LP, Orozco Y, Chicangana GA, Osorio DC. Estimación de la longitud óptima de inserción del tubo orotraqueal en adultos. Rev Colomb Anestesiol. 2016;44:228–234." ] ] "multimedia" => array:6 [ 0 => array:9 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1467 "Ancho" => 2427 "Tamanyo" => 118508 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Distances measured by fiberoptic bronchoscope. M: distance from the proximal edge of the adaptor of the endotracheal tube to the right angle of the mouth. C: distance from the proximal edge of the endotracheal tube adapter to the carina." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 873 "Ancho" => 1501 "Tamanyo" => 164114 ] ] "descripcion" => array:1 [ "en" => "Measuring technique. Placement of adhesive tape (micropore), with direct and pre-determined distances." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SD: standard deviation; CI: confidence interval.Source: authors." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Statistic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mouth-carina distance (cm) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average±SD (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48.5±18 (46.9–50.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">162.2±9 (161.42–162.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.9±1.8 (22.72–23.02) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">162.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Minimum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">135.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">195.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1115452.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of variables studied in the population (n=516)." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: authors." "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">r \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">R2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Adjusted R square \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Std. error of the estimate \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feminine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.249 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.062 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.059 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5310 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masculine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.093 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.089 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7009 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1115454.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col">Model \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Non-standardized coefficients</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Typified coefficients</th><th class="td" title="table-head " align="center" valign="top" scope="col">Sig. \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">B \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Typ. error \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Beta \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">T \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="middle">Feminine</td><td class="td" title="table-entry " align="left" valign="top">B (Constant) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.555 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.043 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.634 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.056 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="middle">Masculine</td><td class="td" title="table-entry " align="left" valign="top">B (Constant) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.413 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.487 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.589 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.072 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.858 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1115451.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Linear regression models by sex." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "OIL: optimal insertion length.Source: authors." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Equation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OIL=11.413+0.072×height (cm)−3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OIL=13.555+0.056×height (cm)−3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1115453.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Prediction equations for endotracheal tube insertion length by sex." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "OIL: optimal insertion length.Source: authors." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OIL women (cm) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">OIL men (cm) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">145–159 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19–20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">160–174 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20–21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">175–189 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21–22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">≥190 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22–23 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1115455.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Optimal insertion length of the endotracheal tube by height and sex." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of two topographical airway length measurements in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.R. 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Statistics

Scientific and Technological Research

Estimación de la longitud óptima de inserción del tubo orotraqueal en adultos

Juan Camilo Gómeza,

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juan.gomez@ucaldas.edu.co

Corresponding author at: calle 68ª N° 9-100, casa 23, conjunto residencial Rincón de la Palma, Manizales, Colombia.

, Lina Paola Melob, Yuliana Orozcob, Gustavo Adolfo Chicanganac, Diana Carolina Osorioc

a Anesthesiologist, Director of Anesthesiology, Universidad de Caldas, Manizales, Colombia

b Anesthesiologist, Universidad de Caldas, Manizales, Colombia

c Third Year Anesthesiology Resident, Universidad de Caldas, Manizales, Colombia

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including cerebral damage in up to 85&#37; of patients&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the correct placement of the tip of the endotracheal tube is a vital element in the practice of anesthesiology and emergency and critical care medicine&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are many methods to check the placement of the endotracheal tube&#44; including the clinical method &#40;auscultation of respiratory sounds&#44; observation of the symmetry of chest expansion&#41;&#44; palpation techniques &#40;palpation of the endotracheal cuff in the suprasternal notch&#41;&#44; imaging methods&#44; capnography&#44; direct visualization of the tip of the tube in relation to the carina using a fiberoptic bronchoscope<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and ultrasound&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> by either visualizing the tube directly in the airway or corroborating bilateral pleural sliding using a linear probe&#46; However&#44; these methods are not always based on evidence&#44; nor are they always cost effective or applicable to every scenario of a given situation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Some authors have found that in 28&#37; of patients with cardiac arrest&#44; intubated by staff trained in advanced life support&#44; the tip of the tube was endobronchial&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Using the traditional insertion method of the endotracheal tube of 21 and 23<span class="elsevierStyleHsp" style=""></span>cm in women and men respectively as proposed in the literature several years ago&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> some publications show figures of more than 33&#46;4&#37; of endotracheal tubes incorrectly placed&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> this being a more frequent adverse event in women than in men &#40;61&#46;9&#37; vs 38&#46;1&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This gap is not considered ideal and is a big unknown when referring to populations with different anatomical proportions to those used in the initial study&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">These considerations then raise the question&#58; in adult patients requiring orotracheal intubation for whatever reason&#44; what is the optimal distance for endotracheal tube insertion&#63;</p><p id="par0025" class="elsevierStylePara elsevierViewall">After an exhaustive search of all available electronic databases &#40;Medline&#44; Embase and Virtual Health Library&#41;&#44; no literature was found that dealt with Latin American or Colombian populations&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Based on this&#44; the objective of this study was to determine the length of optimum insertion of the endotracheal tube based on height for patients undergoing surgical procedures using intubation in two local tertiary hospitals&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A cross-sectional study was conducted with a total population of 516 adults of both sexes&#44; between the ages of 18 and 90&#44; undergoing surgery in the Santa Sofia and SES Hospitals in Caldas&#44; Colombia&#44; between September 2011 and February 2015&#44; classified as ASA I or II&#44; and requiring orotracheal intubation during the procedure&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The minimum sample size &#40;359 patients&#41; was determined with the variance obtained from the height &#40;69&#46;4&#41; from an estimated population of 1800 patients intubated per year in the operating rooms of Santa Sofia Hospital and 1500 patients in the SES Hospital of Caldas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The criteria of exclusion were patients with hemodynamic instability&#44; decompensated cardiorespiratory disease&#44; and anatomical changes to the face&#44; cervical region and upper airway&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The variables studied were simple and grouped by age &#40;under and over the age of 60&#41;&#44; sex&#44; height&#44; distance from the proximal edge of the endotracheal tube adaptor to the right angle of the mouth &#40;<span class="elsevierStyleItalic">M</span>&#41;&#44; distance from the proximal edge of the tube adaptor to the carina &#40;<span class="elsevierStyleItalic">C</span>&#41; and mouth-carina distance &#40;<span class="elsevierStyleItalic">C</span>&#8211;<span class="elsevierStyleItalic">M</span>&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Techniques and procedures</span><p id="par0055" class="elsevierStylePara elsevierViewall">Previous authorization from the bioethics committees of the University of Caldas&#44; the Santa Sof&#237;a Hospital and SES Hospital of Caldas was obtained in accordance with the Helsinki declaration&#44; as well as authorization from each patient by signed&#44; informed consent&#46; Before admission to surgery&#44; data was obtained from the preanesthetic evaluation form to record height&#44; age and sex&#46; In the cases where no height was registered&#44; this was taken by researchers using a height rod with a sensitivity of 1<span class="elsevierStyleHsp" style=""></span>mm and 190<span class="elsevierStyleHsp" style=""></span>cm in length&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The data was obtained from patients who were undergoing general anesthesia in supine position&#44; with the head in neutral position&#44; and monitored using pulse oximetry&#44; capnography&#44; non-invasive blood pressure and electrocardiogram &#40;ECG&#41; with three leads&#46; Each anesthesiologist selected the intubation technique as well as the size of the endotracheal tube and insertion length&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Once the patient was intubated with the endotracheal tube secured to the right labial commissure at a distance considered appropriate by the anesthesiologist&#44; an OLYMPUS LB-GP fiberoptic bronchoscope of dm 4&#46;1<span class="elsevierStyleHsp" style=""></span>mm was inserted through a double lumen tube adaptor to prevent anesthetic circuit disconnection&#46; The distances obtained during the procedure using direct vision of the anatomical structures were the following &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Later&#44; each distance marked on the fiberoptic bronchoscopy was measured using a metallic measuring tape with a sensitivity of one millimeter &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The distance obtained from the proximal edge of the tube to the carina &#40;<span class="elsevierStyleItalic">C</span>&#41; was measured and subtracted from the labial commissure&#44; corresponding to the protruding portion of the mouth tube &#40;<span class="elsevierStyleItalic">M</span>&#41;&#44; which is how the carina-mouth distance &#40;<span class="elsevierStyleItalic">C</span>&#8211;<span class="elsevierStyleItalic">M</span>&#41; was finally determined&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data analysis and software</span><p id="par0075" class="elsevierStylePara elsevierViewall">All primary data was recorded on an instrument designed in Excel and was submitted to a preliminary pilot test for evaluation by experts&#44; who considered the instrument to be adequate and sufficiently clear to collect the necessary data for the study&#46; The statistical analysis was done using SPPS software v 15&#46;0&#44; licensed to the University of Caldas&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The qualitative variable was described using absolute and relative frequency&#46; The quantitative variables were described with the average&#44; confidence interval of 95&#37;&#44; standard deviation&#44; mean&#44; 5 and 95 percentiles and minimum and maximum values&#46; For the prediction of the mouth-carina distance from the height of the patient&#44; a Pearson correlation analysis was conducted after proving the normality of the dependent variable with the Kolmogorov Smirnov test&#46; After this&#44; various linear regression equations for sex and age group were estimated&#46; The results are presented in tables according to the characteristics of the variables&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">516 adults were studied between the ages of 18 and 90&#46; Most of the population was under the age of 60 &#40;71&#46;3&#37;&#41; and a little over half &#40;55&#46;2&#37;&#41; were female&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The results of the study showed that in 41&#46;1&#37; of men and 14&#37; of women the mouth-carina distance was under 23 and 21<span class="elsevierStyleHsp" style=""></span>cm&#44; respectively&#46; In <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; a description of the quantitative variables of the studied population is provided&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">After disaggregating the population data by sex and doing a mouth-carina distance analysis to confirm the normality of the variable&#44; the average mouth-carina distance for men was 23&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#44; and 22&#46;4<span class="elsevierStyleHsp" style=""></span>cm for women&#46; For both sexes the differences between the median and the mean were minimal&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">After doing a linear correlation analysis between the mouth distance variables and height&#44; a direct and statistically significant correlation was found in all cases&#44; for men and women both over and under the age of 60&#46; The highest determination coefficient was for the population equal to or above 60 years of age&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Without controlling for age&#44; and grouping the population by sex and using height as the independent variable&#44; the following linear regression models were obtained &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; along with their respective prediction equations &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">3<span class="elsevierStyleHsp" style=""></span>cm was subtracted from each of the equations obtained&#46; This corresponds&#44; according to the literature&#44; to the distance that the tube should remain from the carina&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;11</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The mouth-carina distance estimated with the prediction equations&#44; without discriminating based on age &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; and taking into account the median height for Colombian men &#40;167<span class="elsevierStyleHsp" style=""></span>cm&#41; and for women &#40;155<span class="elsevierStyleHsp" style=""></span>cm&#41; according to the National Survey of Nutritional Situation in Colombia &#40;Encuesta Nacional de la Situaci&#243;n Nutricional de Colombia&#44; ENSIN 2010&#41;&#44; was as follows&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Men</span>&#58; Mouth-carina distance<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#46;4<span class="elsevierStyleHsp" style=""></span>cm</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Women</span>&#58; Mouth-carina distance<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#46;2<span class="elsevierStyleHsp" style=""></span>cm</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">The findings of this study are coherent with those published by other researchers in different contexts and with different populations&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;7&#44;12&#8211;14</span></a> with regard to the controversy about the appropriate endotracheal tube insertion length for women and men&#44; respectively&#46; Were we to take these measures as a reference in our study&#44; the tube would be endobronchial in 41&#46;1&#37; of men and in 14&#46;1&#37; of women&#46; However&#44; if the equations estimated in this study are considered&#44; endobronchial intubation would be reduced to 2&#46;6&#37; and 5&#37; in men and women&#44; respectively&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Several studies exist of populations of different ethnic origin that relate the length of the airway with height&#46; In 2002&#44; in the Taiwanese population&#44; the length of the airway from the mouth to the carina and its relationship with height was evaluated in 293 patients via fiberoptic bronchoscopy&#44; obtaining a linear regression equation as a result&#58; &#91;height &#40;cm&#41;&#47;5&#93;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>13&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Applying this equation to a Colombian woman with an average height of 155<span class="elsevierStyleHsp" style=""></span>cm&#44; the optimal insertion length of the tube should be left at 18<span class="elsevierStyleHsp" style=""></span>cm&#46; If the same exercise were done&#44; but this time with the equation proposed in this study&#44; the length would be 19&#46;2<span class="elsevierStyleHsp" style=""></span>cm&#44; representing a variation of 1&#46;2<span class="elsevierStyleHsp" style=""></span>cm between the models&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In another study performed in Thailand in 2005 with a population of 100 patients&#44; the Chula formula &#91;4<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;height &#40;cm&#41;&#47;10&#41;&#93; was used to determine the insertion length of the endotracheal tube&#44; which&#44; according to the conclusions&#44; was successful in 99&#37; of patients&#44; insuring that the end of the tube remained at least 2<span class="elsevierStyleHsp" style=""></span>cm above the carina&#44; and that the upper edge of the endotracheal cuff remained at least 2<span class="elsevierStyleHsp" style=""></span>cm below the vocal cords&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> When the equations are compared &#40;the Chula formula and the equation from this study&#41; with a 155<span class="elsevierStyleHsp" style=""></span>cm tall woman&#44; the difference in the optimal insertion length of the tube would be 0&#46;3<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In India in 2011&#44; a study was carried out with 200 patients&#44; concluding when the endotracheal tube is positioned at between 21 and 23<span class="elsevierStyleHsp" style=""></span>cm&#44; the end may come in contact with the carina or become endobronchial&#46; As such&#44; they proposed the following equation for determining the insertion length of the endotracheal tube&#58; &#91;height &#40;cm&#41;&#47;7&#93;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>2&#46;5&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> If we again consider a 155<span class="elsevierStyleHsp" style=""></span>cm tall female patient&#44; the difference in the insertion length when comparing this equation with the proposed equation&#44; would be 0&#46;4<span class="elsevierStyleHsp" style=""></span>cm longer in the patients from India&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The three studies mentioned above were developed with non-Latin American populations&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;8&#44;14</span></a> which may in part explain the difference in their results and those obtained here&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Contrary to what this study reports&#44; some authors have found little correlation between height and airway length&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;13&#44;15</span></a> arguing that this measure correlates between with external topographic measurements such as the distance from the corner of the mouth to the sternal manubrium&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> the distance from the upper incisors to the sternum&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> the distance from the cricoid cartilage to the xiphoid process&#44; the sternal length&#44; the length of the phalanges&#44; the length of the ulna&#44; and length of the foot&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> among others&#46; Nevertheless&#44; the difficulty of obtaining these measurements in emergency situations limits their usefulness and could increase the risk for the patient&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In agreement with other reports from the literature&#44; the results of this study did not show differences related to sex in relation with the length of the airway<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#58; if a man and a woman of equal heights are considered&#44; and the formulas obtained in this study are applied&#44; the mouth-carina distance is minimum&#46; Therefore&#44; it would not be appropriate to propose an optimal endotracheal tube insertion length based exclusively on the sex of the patient&#44; since the height ranges are wide in both men and women&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The limitation of this study lies in the fact that the sample of men and women was not selected at random&#46; The patients included represent those scheduled for surgery during the time assigned for data collection&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">The traditional method of determining the endotracheal tube insertion length as 21<span class="elsevierStyleHsp" style=""></span>cm for women and 23<span class="elsevierStyleHsp" style=""></span>cm for men shows a high incidence of endobrachial intubations&#46; The results of this study present a statistically significant correlation between height and mouth-carina distance&#46; Therefore&#44; the proposed equations based on height dependably predict the optimal endotracheal tube insertion length&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Recomendations</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors propose the used of <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#44; developed with heights for each sex&#44; in which the optimal insertion length of the endotracheal tube is approximated in accordance with the prediction equations obtained in this study&#46; Validating these values in later studies is proposed&#46; Ideally&#44; the above should be complemented with other strategies&#44; such as auscultation&#44; the direct viewing of the endotracheal tube balloon in its passage through the vocal cords&#44; or thorax radiography&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical disclosures</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of human and animal subjects</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0245" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0250" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Financing</span><p id="par0180" class="elsevierStylePara elsevierViewall">The present study was partially financed by the <span class="elsevierStyleGrantSponsor" id="gs1">University of Caldas</span> through recurring resources paid to the main researcher for teaching work and by contributions from Colciencias as support for the young researchers Drs&#46; Lina Paola Melo and Yuliana Orozco as postgraduate residents during the initial phases of this project&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare having no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An accurate estimation of the optimal length of endotracheal tube insertion can prevent complications such as endobronchial intubation&#44; airway trauma and accidental extubation&#44; all of which have a negative impact on patient safety and are associated with an increase in both morbidity and mortality&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the optimal insertion length of endotracheal tubes in female and male adults according to their height&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional analytical study conducted with 516 adult ASA I-II female and male patients who had different surgical procedures requiring endotracheal intubation&#46; The mouth-carina distance was obtained using a flexible fiberoptic bronchoscope&#46; The data analysis was performed using the SPSS 15&#46;0 software&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Height and mouth-carina distance showed a direct and statistically significant correlation&#46; Two equations for estimating optimal endotracheal insertion length were obtained&#44; according to sex&#58; men<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#46;413<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#46;072<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>height in cm&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>3&#59; and women<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#46;555<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#46;056<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>height in cm&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>3&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The traditional method of determining the insertion length of the endotracheal tube&#44; 21<span class="elsevierStyleHsp" style=""></span>cm for women and 23<span class="elsevierStyleHsp" style=""></span>cm for men&#44; shows a high incidence of endobronchial intubations in the analyzed population&#46; The optimal insertion depth of the endotracheal tube can be reliably estimated through the use of prediction equations based on patient height&#44; as proposed in this study&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Materials and Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusion"
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        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Una correcta estimaci&#243;n de la longitud &#243;ptima de inserci&#243;n del tubo orotraqueal puede prevenir complicaciones como&#58; intubaci&#243;n endobronquial&#44; trauma de la v&#237;a a&#233;rea y extubaci&#243;n accidental&#44; las cuales inciden de manera negativa en la seguridad del paciente y se asocian con aumento en la morbimortalidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar la longitud de inserci&#243;n &#243;ptima del tubo orotraqueal a partir de la talla en pacientes adultos de ambos sexos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio anal&#237;tico de corte transversal en 516 pacientes adultos de ambos sexos&#44; ASA I o II&#44; intervenidos quir&#250;rgicamente&#44; quienes requirieron intubaci&#243;n orotraqueal durante su procedimiento&#46; La distancia boca-carina fue obtenida con la ayuda de un fibrobroncoscopio&#46; El an&#225;lisis de datos se efectu&#243; con el software SPSS 15&#46;0&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La talla y la distancia boca-carina mostraron una correlaci&#243;n directa y estad&#237;sticamente significativa&#46; Se obtuvieron dos ecuaciones para estimar la longitud de inserci&#243;n &#243;ptima del tubo orotraqueal discriminadas seg&#250;n el sexo&#58; hombres<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#44;413<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;072 x talla en cm&#41; - 3&#59; mujeres<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#44;555<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#40;0&#44;056 x talla en cm&#41; - 3&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El m&#233;todo tradicional para establecer la longitud de inserci&#243;n del tubo orotraqueal de 21<span class="elsevierStyleHsp" style=""></span>cm para mujeres y de 23<span class="elsevierStyleHsp" style=""></span>cm para hombres&#44; muestra una alta incidencia de intubaciones endobronquiales en la poblaci&#243;n estudiada&#46; La longitud de inserci&#243;n &#243;ptima del tubo orotraqueal se puede determinar de forma segura a partir de las ecuaciones de predicci&#243;n&#44; basadas en la talla&#44; propuestas en este estudio&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Materiales y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; G&#243;mez JC&#44; Melo LP&#44; Orozco Y&#44; Chicangana GA&#44; Osorio DC&#46; Estimaci&#243;n de la longitud &#243;ptima de inserci&#243;n del tubo orotraqueal en adultos&#46; Rev Colomb Anestesiol&#46; 2016&#59;44&#58;228&#8211;234&#46;</p>"
      ]
    ]
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                  <table border="0" frame="\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Height &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18 &#40;46&#46;9&#8211;50&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">162&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 &#40;161&#46;42&#8211;162&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;8 &#40;22&#46;72&#8211;23&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Median&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">162&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Minimum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">195&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "fuente" => "<span class="elsevierStyleItalic">Source</span>&#58; authors&#46;"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">r</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;249&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;059&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5310&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Masculine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;089&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Model&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Non-standardized coefficients</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Typified coefficients</th><th class="td" title="table-head  " align="center" valign="top" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Typ&#46; error&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Beta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="middle">Feminine</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">B</span> &#40;Constant&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;555&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;043&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;634&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;487&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;589&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;858&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Linear regression models by sex&#46;</p>"
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Article information

ISSN: 22562087
Original language: English

DOI:10.1016/j.rcae.2016.05.005

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	90	2	92
2024 October	932	12	944
2024 September	1222	18	1240
2024 August	988	9	997
2024 July	1222	14	1236
2024 June	834	15	849
2024 May	814	4	818
2024 April	953	23	976
2024 March	1191	34	1225
2024 February	1192	19	1211
2024 January	1151	11	1162
2023 December	875	12	887
2023 November	710	21	731
2023 October	802	8	810
2023 September	384	7	391
2023 August	241	14	255
2023 July	179	8	187
2023 June	138	3	141
2023 May	161	4	165
2023 April	103	6	109
2023 March	107	8	115
2023 February	68	4	72
2023 January	61	2	63
2022 December	73	4	77
2022 November	72	10	82
2022 October	55	15	70
2022 September	69	11	80
2022 August	55	6	61
2022 July	39	7	46
2022 June	28	9	37
2022 May	42	11	53
2022 April	25	5	30
2022 March	53	7	60
2022 February	45	5	50
2022 January	78	4	82
2021 December	71	6	77
2021 November	73	8	81
2021 October	93	13	106
2021 September	47	9	56
2021 August	18	5	23
2021 July	16	6	22
2021 June	23	5	28
2021 May	16	6	22
2021 April	53	6	59
2021 March	20	5	25
2021 February	7	10	17
2021 January	15	7	22
2020 December	8	7	15
2020 November	11	7	18
2020 October	8	6	14
2020 September	14	8	22
2020 August	8	5	13
2020 July	11	9	20
2020 June	8	3	11
2020 May	9	4	13
2020 April	3	3	6
2020 March	8	3	11
2020 February	9	2	11
2020 January	8	2	10
2019 December	10	5	15
2019 November	6	3	9
2019 October	5	3	8
2019 September	6	3	9
2019 August	2	1	3
2019 July	0	3	3
2019 June	3	7	10
2019 May	1	7	8
2019 January	1	0	1
2018 September	1	0	1
2018 June	15	4	19
2018 May	102	10	112
2018 April	178	6	184
2018 March	121	9	130
2018 February	53	4	57
2018 January	66	6	72
2017 December	82	6	88
2017 November	71	5	76
2017 October	45	9	54
2017 September	65	8	73
2017 August	65	5	70
2017 July	63	2	65
2017 June	46	18	64
2017 May	61	9	70
2017 April	62	10	72
2017 March	41	13	54
2017 February	22	1	23
2017 January	29	5	34
2016 December	41	15	56
2016 November	39	21	60
2016 October	71	24	95
2016 September	128	22	150
2016 August	77	16	93
2016 July	36	12	48

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