Changes in nasotracheal tube depth in response to head and neck movement in children

Yamanaka, Hitoshi; Tsukamoto, Masanori; Hitosugi, Takashi; Yokoyama, Takeshi

doi:10.1111/aas.13207

Cited by 12 publications

(11 citation statements)

References 24 publications

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“…After choosing the appropriate tube diameter, the nasotracheal tube should be inserted into the appropriate position as head and neck surgery involves various neck positions and it is difficult to approach and manage the tube during the surgery. The changes in neck position can cause changes in the tracheal length [32], and the direction of tube displacement is usually cephalad with head extension and caudal with head flexion, although head extension caused unintended right main stem intubation in 4% of patients in a previous study [4]. Neck flexion and extension resulted in a tube displacement of more than 10 mm in more than 70% of patients in another study [17].…”

Section: Plos Onementioning

confidence: 90%

Comparison of the selection of nasotracheal tube diameter based on the patient’s sex or size of the nasal airway: A prospective observational study

et al. 2021

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When selecting the nasotracheal tube diameter for nasotracheal intubation, atraumatic introduction of the tube through the nasal passage and a safe location of the tube’s cuff and tip should be ensured simultaneously. To maintain safety margin for the tube’s cuff and tip from the vocal cords and carina (2 cm and 3 cm, respectively), the maximum allowable proximal-cuff-to-tip distance was calculated as 5 cm less than the measured vocal cords-to-carina distance. The primary aim of this study was to find a single predictive preoperative factor of the nostril size and maximum allowable proximal-cuff-to-tip distance of nasotracheal tubes. The secondary aim was to compare the difference in the safety margin between the maximum allowable proximal-cuff-to-tip distance based on the patient’s airway and the actual proximal-cuff-to-tip distance of the selected tube. We used fiberoptic bronchoscope to measure the distance from the vocal cords to the carina for the calculation of the maximum allowable proximal-cuff-to-tip distance. We analyzed the association of preoperative characteristics such as age, sex, height, and weight with the nostril size and maximum allowable proximal-cuff-to-tip distance. The proportion of patients with appropriate locations of both the cuff and tip was evaluated. Sex and height were significant predictive factors of the nostril size and maximum allowable proximal-cuff-to-tip distance, respectively (p = 0.0001 and p = 0.0048). The difference in the safety margin was significantly decreased when the tube diameter was selected based on the nostril size rather than by sex (p<0.0001). The proportion of patients who had the appropriate cuff/tip location was significantly larger (75.2%) when the tube diameter was selected by sex compared to when it was selected by the nostril size (65%) (p<0.0001). It is more suitable to select the nasotracheal tube diameter based on sex rather than by nostril size to ensure the safe location of the tube’s cuff and tip simultaneously.

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Section: Plos Onementioning

confidence: 90%

Comparison of the selection of nasotracheal tube diameter based on the patient’s sex or size of the nasal airway: A prospective observational study

et al. 2021

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“…Yamanaka et al investigated the airway length changes during nasotracheal intubation in pediatric patients. They found that the head flexion-to-extension positional changes caused a slight change in the length of the pharyngeal cavity, the authors asserted that the cuff position was also likely to be changed [23]. Hartrey et al found that the magnitude of movement was smaller with nasotracheal, compared to that with orotracheal tubes [19].…”

Section: Discussionmentioning

confidence: 99%

Effects of Head and Neck Position on Nasotracheal Tube Intracuff Pressure: A Prospective Observational Study

Kim

Jang

Kim

et al. 2021

JCM

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To prevent endotracheal tube-related barotrauma or leakage, the intracuff pressure should be adjusted to 20–30 cm H2O. However, changes in the nasotracheal tube intracuff pressure relative to neck posture are unclear. In this study, we investigated the effect of head and neck positioning on nasotracheal tube intracuff pressure. Fifty adult patients with nasotracheal tubes who were scheduled for surgery under general anesthesia were enrolled. Following intubation, intracuff pressure was measured by connecting the pilot balloon to a device that continuously monitors the intracuff pressure. Subsequently, the intracuff pressure was set to 24.48 cm H2O (=18 mmHg) for the neutral position. We recorded the intracuff pressures based on the patients’ position during head flexion, extension, and rotation. The initial intracuff pressure was 42.2 cm H2O [29.6–73.1] in the neutral position. After pressure adjustment in the neutral position, the intracuff pressure was significantly different from the neutral to flexed (p < 0.001), extended (p = 0.003), or rotated (p < 0.001) positions. Although the median change in intracuff pressure was <3 cm H2O when each patient’s position was changed, overinflation to >30 cm H2O occurred in 12% of patients. Therefore, it is necessary to adjust the intracuff pressure after tracheal intubation and each positional change.

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“…The reinforced ETT was equipped with a spiral hose on the inner wall and a spring inside the spiral hose, which made the tube soft and flexible, as well as resistant to bending and compression. The trachea was a cylindrical tube, supported by “C” shaped tracheal cartilage, connected by a cricoid ligament, and surrounded by smooth muscle tissue and fibrous connective tissue to form a membranous wall ( 5 ). The trachea’s anatomical characteristics allowed it to be flexible enough to accommodate the head movements.…”

Section: Discussionmentioning

confidence: 99%

“…However, Hartrey and Kestin ( 23 ) discovered no difference in ETT displacement between oral and nasal intubations during head extension or flexion in adults. Another study ( 5 ) reported that the trachea length and the distance between the nares and the vocal cords were both changed during head extension or flexion in children. And the displacement of the ETT depended mainly on the changes in trachea length.…”

Section: Discussionmentioning

confidence: 99%

“…During head flexion, the ETT tip had been observed to move toward the carnia, inducing endobronchial intubation and even hypoxia. On the contrary, the ETT tip moved toward the vocal cord in the head extension (5)(6)(7)(8)(9)(10)(11). However, in the previous studies, the distance of the ETT tip movement varied with different angles of head position.…”

Section: Introductionmentioning

confidence: 99%

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Effect of head position changes on the depth of tracheal intubation in pediatric patients: A prospective, observational study

2022

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PurposeThe purpose of this study was to investigate the effect of changing head position on the endotracheal tube (ETT) depth and to assess the risk of inadvertent extubation and bronchial intubation in pediatric patients.MethodsSubjects aged 4–12 years old with orotracheal intubation undergoing elective surgeries were enrolled. After induction, the distances between “the ETT tip and the trachea carina” (T-C) were measured using a Disposcope flexible endoscope in head neutral position, 45° extension and flexion, 60° right and left rotation. The distance of the ETT tip movement relative to the neutral position (ΔT-C) was calculated after changing the head positions. The direction of the ETT tip displacement and the adverse events including endobronchial intubation, accidental tracheal extubation, hoarseness and sore throat were recorded.ResultsThe ETT tip moved toward the carina by 0.5 ± 0.4 cm (P < 0.001) when the head was flexed. After extending the head, the ETT tip moved toward the vocal cord by 0.9 ± 0.4 cm (P < 0.001). Right rotation resulted that the ETT tip moved toward the vocal cord direction by 0.6 ± 0.4 cm (P < 0.001). Moreover, there was no displacement with the head on left rotation (P = 0.126). Subjects with the reinforced ETT had less ETT displacement after changing head position than the taper guard ETT.ConclusionThe changes of head position can influence the depth of the ETT especially in head extension. We recommend using the reinforced ETT to reduce the ETT displacement in pediatrics to avoid intubation complications.Clinical trial registration[www.ClinicalTrials.gov], identifier, [ChiCTR2100042648].

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Changes in nasotracheal tube depth in response to head and neck movement in children

Abstract: A change in the position of the tracheal tube tip in the trachea depends mainly on changes in t-length during paediatric dental surgery.

Cited by 12 publications

References 24 publications

Comparison of the selection of nasotracheal tube diameter based on the patient’s sex or size of the nasal airway: A prospective observational study

Comparison of the selection of nasotracheal tube diameter based on the patient’s sex or size of the nasal airway: A prospective observational study

Effects of Head and Neck Position on Nasotracheal Tube Intracuff Pressure: A Prospective Observational Study

Effect of head position changes on the depth of tracheal intubation in pediatric patients: A prospective, observational study

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