Clinical evaluation of cuff and tube tip position in a newly designed paediatric preformed oral cuffed tracheal tube

Weiß, Markus; Dullenkopf, Alexander; Bøttcher, Susanne Gammelgaard; Schmitz, A.; Stutz, K.; Gysin, Claudine; Gerber, Andri

doi:10.1093/bja/ael247

Cited by 40 publications

(37 citation statements)

References 21 publications

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“…It has correctly placed depth markings and has low tube exchange rate [Figure 3]. [37–39] A prospective, randomized, controlled multi-center trial by Weiss et al . has demonstrated the benefits of this tube in terms of number of tube exchanges, post-extubation stridor, and aspiration.…”

Section: Introductionmentioning

confidence: 99%

Pediatric cuffed endotracheal tubes

Bhardwaj

2013

J Anaesthesiol Clin Pharmacol

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Endotracheal intubation in children is usually performed utilizing uncuffed endotracheal tubes for conduct of anesthesia as well as for prolonged ventilation in critical care units. However, uncuffed tubes may require multiple changes to avoid excessive air leak, with subsequent environmental pollution making the technique uneconomical. In addition, monitoring of ventilatory parameters, exhaled volumes, and end-expiratory gases may be unreliable. All these problems can be avoided by use of cuffed endotracheal tubes. Besides, cuffed endotracheal tubes may be of advantage in special situations like laparoscopic surgery and in surgical conditions at risk of aspiration. Magnetic resonance imaging (MRI) scans in children have found the narrowest portion of larynx at rima glottides. Cuffed endotracheal tubes, therefore, will form a complete seal with low cuff pressure of <15 cm H2O without any increase in airway complications. Till recently, the use of cuffed endotracheal tubes was limited by variations in the tube design marketed by different manufacturers. The introduction of a new cuffed endotracheal tube in the market with improved tracheal sealing characteristics may encourage increased safe use of these tubes in clinical practice. A literature search using search words "cuffed endotracheal tube" and "children" from 1980 to January 2012 in PUBMED was conducted. Based on the search, the advantages and potential benefits of cuffed ETT are reviewed in this article.

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Section: Introductionmentioning

confidence: 99%

Pediatric cuffed endotracheal tubes

Bhardwaj

2013

J Anaesthesiol Clin Pharmacol

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“…This could result in variable tube positions, which may be exacerbated during head and neck movement. 22 Therefore, inadvertent tube malpositioning could occur more often with preformed RAE tubes than with straight tubes. The present study has only assessed RAE tube migration during neck extension with a 10-cm shoulder positioner, which is a limitation of this study.…”

Section: Discussionmentioning

confidence: 99%

Correlation between changes in thyromental distance and distance of migration of oral Ring-Adair-Elwyn tubes during neck extension with a shoulder positioner in patients undergoing neck procedures

et al. 2015

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Objectives: To measure the migration of oral Ring-Adair-Elwyn (RAE) preformed tracheal tubes during neck extension compared with the neutral neck position, and to assess the correlation between changes in the thyromental distance (TMD) during changes in neck position and tracheal tube migration. Methods: This prospective observational study enrolled adult patients undergoing elective neck or thyroid procedures below the mandible. Using fibreoptic bronchoscopy, distances from the RAE tube adapter to the carina and to the tube tip were measured in the neutral position and after neck extension with a 10 cm D-shaped gel shoulder positioner. The change in distance of the RAE tube tip migration was compared with the change in TMD in each patient. Results: This study enrolled 106 patients. During neck extension with a 10-cm shoulder positioner, RAE tubes cranially migrated 2.7 cm from the neutral position, but RAE tube migration was not correlated with the change in external TMD. Conclusion: Oral RAE tube migration was not significantly correlated with the change in external TMD. Due to their large variability, changes in TMD were not useful predictors of RAE tube migration.

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“…The recommended tube size selection resulted in a low tube exchange rate of 0-1.6 % in children aged from birth to 16 years. [33,48,[55][56][57].…”

Section: Package With Tube and Patient-related Informationmentioning

confidence: 99%

“…[33,48,[55][56][57]. The Microcuff PET is provided with a pediatric cuff manometer and a cuff pressure release valve which limits the cuff pressure at about 20 cm H 2 O (FIGURE 4) [58].…”

Section: Package With Tube and Patient-related Informationmentioning

confidence: 99%

“…In the meantime many clinical studies with the Microcuff PET are available and provide information for further improvement of the design of cuffed tracheal tubes in general [48,[55][56][57]70,71]. In particular, longer distances from the intubation depth mark to the upper cuff border are needed to guarantee that the cuff is placed below the vocal cords in larger children of a tracheal tube size-intended age group and during head-neck extension [48,55].…”

Section: Package With Tube and Patient-related Informationmentioning

confidence: 99%

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Cuffed tracheal tubes in children: past, present and future

Weiß¹,

Dullenkopf

2007

Expert Review of Medical Devices

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This article reviews recent developments and core topics in the use and design of pediatric cuffed tracheal tubes. A concept for an appropriate pediatric cuffed tracheal tube is introduced. The main points in this concept are evidence-based tracheal tube size recommendation, continuous cuff pressure monitoring and a pediatric tracheal tube with an anatomically-based intubation depth mark and a short distally placed high-volume-low pressure cuff made from an ultra-thin polyurethane membrane with markedly improved tracheal sealing performance. The main points in proper handling of cuffed tracheal tubes in children are highlighted. Finally, an outlook on future developments in the design of pediatric cuffed tracheal tubes and an overview of tasks to be performed in evaluating them is given.

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Clinical evaluation of cuff and tube tip position in a newly designed paediatric preformed oral cuffed tracheal tube

Abstract: The new oral preformed cuffed tracheal tubes allow safe placement in almost all patients when inserted according to the tube bend. The critically low tube tip and the high cuff positions in a few tubes when placed according to the tube bend requires clinical alertness.

Cited by 40 publications

References 21 publications

Pediatric cuffed endotracheal tubes

Pediatric cuffed endotracheal tubes

Correlation between changes in thyromental distance and distance of migration of oral Ring-Adair-Elwyn tubes during neck extension with a shoulder positioner in patients undergoing neck procedures

Cuffed tracheal tubes in children: past, present and future

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