Association of postoperative airway complications with ultrasonographic measurements in pediatric patients: An exploratory analysis

Objective: Postoperative airway complications pose significant risks in pediatric patients and are often multifactorial. Anatomical and physiological differences in children make predicting these complications challenging. This study examines the association between ultrasonographic (USG) measurements and postoperative airway complications, primarily focusing on the subglottic diameter-to-wall thickness difference ratio. Methods: This prospective, double-blind study included pediatric patients aged 1–11 undergoing elective surgery between January and July 2024. Demographic and perioperative data, USG-measured airway diameters, wall thicknesses, and endotracheal tube (ETT) positions were recorded. The subglottic diameter-to-wall thickness difference ratio was the primary ultrasonographic measurement. Airway complications were assessed within the first postoperative hour, including cough, dysphonia, and laryngospasm. The relationship between USG measurements and complications was analyzed. Results: Eighty patients were included, and airway complications were observed in 37.5% ( n = 30). Patients with complications had lower height, subglottic diameter, and subglottic diameter-to-wall thickness difference ratio but higher subglottic wall and vocal cord thickness differences. In 70% ( n = 20) of these cases, ETT had shifted superiorly from the second tracheal ring. The subglottic diameter-to-wall thickness difference ratio was significantly associated with complications (AUC 0.896, cutoff 32, sensitivity 80%, specificity 92%). ETT positioned above the second tracheal ring was also associated with increased complication risk (OR = 107.747, 95% CI: 5.305–2188.504, P = 0.002). Conclusion: USG appears to be a valuable tool for assessing the association between the subglottic diameter-to-wall thickness difference ratio and postoperative airway complications in pediatric patients. Accurate evaluation of subglottic edema and proper ETT placement using USG may enhance patient safety.