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Chapter 14 - Ultrasonography for Airway Management

from Section 2 - Devices and Techniques to Manage the Abnormal Airway

Published online by Cambridge University Press:  10 September 2019

Narasimhan Jagannathan
Affiliation:
Northwestern University Medical School, Illinois
John E. Fiadjoe
Affiliation:
Children’s Hospital of Philadelphia
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Summary

There is no single ultrasound probe available that allows visualization of all airway structures in children of all ages. In larger children above approximately 8 years of age, the linear medium-to-high frequency (5–14 MHz) transducer is suitable for imaging superficial airway structures (within 0–5 cm beneath the skin surface). The curved low-frequency transducer (~4.0 MHz) is most suitable for obtaining sagittal and parasagittal views of the tongue and structures in the submandibular and supraglottic regions, mainly because of its wider field of view. Linear transducers, which are used for assessment of the upper airways, provide excellent images of superficial structures, such as ribs and the pleura, but deeper structures can be difficult to assess. A micro-convex transducer (~8.0 MHz) is a good all-round transducer for focused ultrasonographic examination of the lungs, since most micro-convex transducers have an acceptable image quality of both superficial (pleura) and deeper structures (e.g., lung consolidation, atelectasis). Furthermore, micro-convex transducers are often small, which makes it easier to access the posterior thoracic wall, when the patient can only be examined in the supine position. An alternative to the micro-convex transducer for examination of the lungs is the curved low-frequency transducer (~4.0 MHz), which also has an acceptable image quality of both superficial and deeper structures. Since visualization of superficial and deep structures is needed, it is important to continuously optimize transducer frequency to obtain the best possible images. The presence or absence of artifacts are an important part of lung ultrasonography; hence, one should be mindful to deactivate any image optimization software that is inherently built into newer ultrasound machines as this would remove or diminish the presence of these useful artifacts when performing lung ultrasonography.

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Publisher: Cambridge University Press
Print publication year: 2019

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References

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