Coniotomie: Quel diamètre ?

Morphometric analysis and clinical application of the working dimensions of cricothyroid membrane in south Indian adults: With special relevance to surgical cricothyroidotomy

 Prithishkumar IJ et Al. Emergency Medicine Australasia (2010) 22, 13–20

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L'anatomie de la membrane cricoïdienne fait l'objet de nombreuses description. Un des intérêts de ces dernières est de préciser la taille de cette dernière et d'en déduire le diamètre de canule/sonde le plus adapté pour une insertion intratrachéale. Il existe de grandes variations selon les populations étudiées, ici indienne. On peut retenir pour  notre population militaire essentiellement masculine une hauteur de  6 mm pour une largeur de 8 mm. C'est pourquoi la taille maximale des canules insérées à ce niveau ne doit excéder ces dimensions.

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Objective: To measure the working dimensions of the cricothyroid membrane in the adult south Indian population and to establish the association between the working dimensions and the appropriate endotracheal tube size for the purpose of cricothyroidotomy.

Methods: Cross-sectional evaluation of 50 fresh adult autopsy cases (35 men, 15 women) in a medical university teaching hospital in South India.

Results: Age ranged from 17.0 to 83.0 years. Working dimensions of the membrane in neutral position of neck, in men: width = 8.41  2.11 mm, height = 6.57  1.87 mm; in women: width = 6.30  1.29 mm, height = 5.80  1.56 mm. Depth of the subglottic larynx at the level of cricoid cartilage: men = 20.73  1.97 mm, women = 15.62  1.71 mm. Distance of the lower border of cricothyroid membrane from suprasternal notch in neutral position of neck, in men = 5.18  1.76 cm, women = 4.72  1.55 cm; in passively extended neck, men = 7.86  1.25 cm, women = 8.05  1.28 cm. Regression equations have been derived to determine endotracheal tube size for cricothyroidotomy, based on distance between sternal  notch and chin, and height of the individual (P < 0.05).

Conclusions: Working dimensions are smaller in the Indian group compared with western publications. Endotracheal tubes ranging from size 3.0 to 6.0 might be used for cricothyroidotomy in the adult south Indian population.