Clinical Implications of Vocal Cord-Carina Distance and Tracheal Length in the Indian Population

Kumari, Shashi; Prakash, Smita; Mullick, Parul; Guria, Sushil; Girdhar, Kiran Kumar

doi:10.5152/tjar.2019.20856

Cited by 8 publications

(11 citation statements)

References 16 publications

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“…VKM'nin doğru bir şekilde ölçülebilmesi için entübasyon sırasında vokal kordların net olarak görülmesi (Cormack-Lehane I-II) ve ET üzerinde bulunan işaret noktasının tam olarak vokal kordlarda bırakılması gerekmektedir. Biz de çalışmamızda, diğer çalışmalardan [13] farklı olarak Cormack-Lehane 3 ve 4 olan hastaları da çalışmamıza dâhil edebilmek amacıyla video laringoskopun zor entübasyon bleydi kullanılarak tüp üzerinde bulunan işaret çizgilerini tam olarak vokal kordlar üzerinde bırakmasını sağladık.…”

Section: Discussionunclassified

Measurement of Vocal Cord-Carina Distance with Disposcope Endoscope and Determination of Correlation with Anatomical Measurements of Body Surface

Karataş¹,

Kara²,

Özkan³

et al. 2020

GKDA

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Entübasyon işlemi sırasında endobronşiyal entübasyon, vokal kord ve sinir basısı, baş boyun hareketine bağlı beklenmedik ekstübasyon gibi komplikasyonların önüne geçebilmek için tüp ucu trakea içerisinde uygun seviyede yerleştirilmelidir. Vokal kord-karina mesafesi kısa olan hastalarda tüp ucu yerleşimi ile ilgili sorunların daha sık yaşanabileceği gözönünde bulundurulduğunda, bu hastaların önceden tahmin edilmesi, bu gibi komplikasyonları önleyecektir. Biz de bu amaçla çalışmamızda vokal kord-karina mesafesi ile vücut yüzey anatomik ölçümleri arasında bir korelasyon olup olmadığını araştırdık. Yöntem: Çalışmaya 200 hasta dâhil edildi. Hastaların çeşitli hava yolu ölçümlerinin yanı sıra farklı vücut yüzey anatomik ölçümleri kaydedildi. Endotrakeal entübasyonu takiben Disposcope® cihazı yardımı ile endotrakeal tüp üzerine yerleştirilen çizgiler kullanılarak vokal kord-karina mesafelerini hesapladık. Bulgular: Kadın ve erkeklerin ortalama vokal kord karina mesafesi 13.1±1.9 cm olarak bulundu. Hastalardan 9'unun (%4,5) vokal kord karina mesafesi 10,5 cm veya daha azdı. Toplam 34 hastada (%17) vokal kord karina mesafesi 11.2 cm'nin altında olup, vokal kord karina mesafesinin kısa olduğu belirlendi. Vokal kord karina mesafesi ile en iyi korele olan anatomik ölçümler sırasıyla sternomental mesafe (r=0.358), boy (r=0.270) ve ulnar uzunluk (r=0.256) olarak bulundu. Sonuç: Vücut yüzey anatomik ölçümleri ile vokal kord karina mesafesi arasındaki korelasyonların zayıf olduğunu belirledik. Vokal kord karina mesafesi kısa olan hastaların vücut yüzey anatomik ölçümleri ile önceden tahmin edilmesinin hâlâ zor olduğunu düşünmekteyiz. İşaret çizgilerinin tüp ucuna olan uzaklığı 10 cm'den küçük olan endotrakeal tüplerin, Türk erişkin hastaların büyük çoğunluğunda güvenle kullanılabileceği sonucuna vardık.

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Section: Discussionunclassified

Measurement of Vocal Cord-Carina Distance with Disposcope Endoscope and Determination of Correlation with Anatomical Measurements of Body Surface

Karataş¹,

Kara²,

Özkan³

et al. 2020

GKDA

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“…Measurements using FOB and airway USG were performed as described in the previous literature. [ 10 11 ]…”

Section: Methodsmentioning

confidence: 99%

“…In Indian adults, the reported average cricoid-to-carina distance (D CrC ) is 9.7–11.2 cm in males and 9.4–10.4 cm in females. [ 9 10 ] Hence, while securing the ETT by the IGM technique, placing fixed length (≈ 9 cm) of commercially available tubes beyond the vocal cords could lead to suboptimal placement. [ 9 ] However, placing the proximal cuff just beyond the cricoid-cartilage is likely to provide optimal ETT placement as only around 6–7 cm segment of the ETT (between proximal end of cuff to tube tip) lies beyond the cricoid.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of the three-point cuff palpation technique in preventing endobronchial tube migration during positioning in robotic pelvic surgeries

Mittal¹,

Dubey²,

Shukla³

et al. 2022

Indian Journal of Anaesthesia

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Background and Aims: During robotic pelvic surgeries, the shortening of endotracheal tube (ETT) tip-to-carina distance (D TC ) during pneumoperitoneum with 45° Trendelenburg position can result in endobronchial tube migration. In the three-point ETT cuff palpation (TPP) technique, maximal ETT cuff distension is felt over the tracheal segment located between the cricoid-thyroid membrane and suprasternal notch, which is likely to provide optimal placement. However, the reproducibility and reliability of the TPP technique in preventing endobronchial tube migration are yet to be evaluated. Hence, we compared three ETT placement techniques: TPP technique, intubation guide mark (IGM) technique and Varshney’s formula (VF) for the prevention of endobronchial tube migration during robotic pelvic surgeries. Methods: ETT placement by TPP was compared with IGM and VF techniques in 100 American Society of Anesthesiologists physical class II-III patients, by assessing the serial changes in D TC and incidence of endobronchial tube migration throughout the different phases of pneumoperitoneum and Trendelenburg position using t-test and Chi-square test. Changes in the D TC during various phases were also measured. Results: D TC (mean ± standard deviation) at baseline and during pneumoperitoneum was significantly better in TPP technique (2.80 ± 0.62 cm and 1.96 ± 0.66 cm) as compared to both IGM (2.50 ± 1.27 cm and 1.41 ± 1.29 cm) and VF techniques (1.83 ± 1.13 cm and 0.98 ± 1.18 cm), P < 0.001. During pneumoperitoneum, the mean shortening of D TC was 0.84 ± 0.20 cm, and no endobronchial tube migration was found in TPP technique compared to 20% in IGM and 25% in VF techniques, P < 0.001. Conclusion: TPP is a simple and reliable technique, which provides optimal ETT placement and prevents endobronchial tube migration throughout the different phases of robotic pelvic surgeries.

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“…Several methods have been proposed to determine the appropriate ET placement. Methods for determining the appropriate depth of ET include age, height, ET internal diameter (ID)-based formulas, chest X-ray-based methods, and fiberoptic bronchoscopy 9 , 10 . Previous studies have shown that these methods have limitations in clinical practice due to the lack of accuracy of formula-based methods and the inconvenience of using the equipment.…”

Section: Introductionmentioning

confidence: 99%

Predicting the risk of inappropriate depth of endotracheal intubation in pediatric patients using machine learning approaches

Shim

Lee

et al. 2023

Sci Rep

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Endotracheal tube (ET) misplacement is common in pediatric patients, which can lead to the serious complication. It would be helpful if there is an easy-to-use tool to predict the optimal ET depth considering in each patient’s characteristics. Therefore, we plan to develop a novel machine learning (ML) model to predict the appropriate ET depth in pediatric patients. This study retrospectively collected data from 1436 pediatric patients aged < 7 years who underwent chest x-ray examination in an intubated state. Patient data including age, sex, height weight, the internal diameter (ID) of the ET, and ET depth were collected from electronic medical records and chest x-ray. Among these, 1436 data were divided into training (70%, n = 1007) and testing (30%, n = 429) datasets. The training dataset was used to build the appropriate ET depth estimation model, while the test dataset was used to compare the model performance with the formula-based methods such as age-based method, height-based method and tube-ID method. The rate of inappropriate ET location was significantly lower in our ML model (17.9%) compared to formula-based methods (35.7%, 62.2%, and 46.6%). The relative risk [95% confidence interval, CI] of an inappropriate ET location compared to ML model in the age-based, height-based, and tube ID-based method were 1.99 [1.56–2.52], 3.47 [2.80–4.30], and 2.60 [2.07–3.26], respectively. In addition, compared to ML model, the relative risk of shallow intubation tended to be higher in the age-based method, whereas the risk of the deep or endobronchial intubation tended to be higher in the height-based and the tube ID-based method. The use of our ML model was able to predict optimal ET depth for pediatric patients only with basic patient information and reduce the risk of inappropriate ET placement. It will be helpful to clinicians unfamiliar with pediatric tracheal intubation to determine the appropriate ET depth.

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Clinical Implications of Vocal Cord-Carina Distance and Tracheal Length in the Indian Population

Abstract: the manuscript, references should be cited using Arabic numbers in parentheses. The reference styles for different types of publications are presented in the following examples.

Cited by 8 publications

References 16 publications

Measurement of Vocal Cord-Carina Distance with Disposcope Endoscope and Determination of Correlation with Anatomical Measurements of Body Surface

Measurement of Vocal Cord-Carina Distance with Disposcope Endoscope and Determination of Correlation with Anatomical Measurements of Body Surface

Efficacy of the three-point cuff palpation technique in preventing endobronchial tube migration during positioning in robotic pelvic surgeries

Predicting the risk of inappropriate depth of endotracheal intubation in pediatric patients using machine learning approaches

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