Ideal Length of Oral Endotracheal Tube for Critically Ill Intubated Patients in an Asian Population: Comparison to Current Western Standards

Lal, Amos; Pena, Eleanor Dela; Sarcilla, Dizon J; Perez, Peter P; Wong, Chiew Meng Johnny; Khan, Faheem Ahmed

doi:10.7759/cureus.3590

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…The decision of offering ECMO as a lifesaving modality needs to be considered after taking in accounts multiple patient and hospital related factors. If other modalities of improving oxygenation and ventilation such as prone positioning, pharmacological paralysis to improve ventilator synchrony and reduced work of breathing should be tried first [9,33,39,42,43]. Fortunately, early ECMO initiation was lifesaving in our patient.…”

Section: Discussionmentioning

confidence: 91%

Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome

Lal

Mishra

Akhtar

et al. 2021

Monaldi Arch Chest Dis

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COVID-19 has involved numerous countries across the globe and the disease burden, susceptible age group; mortality rate has been variable depending on the demographical profile, economic status, and health care infrastructure. In the current clinical environment, COVID-19 is one of the most important clinical differential diagnoses in patients presenting with respiratory symptoms. The optimal mechanical ventilation strategy for these patients has been a constant topic of discussion and very importantly so, since a great majority of these patients require invasive mechanical ventilation and often for an extended period of time. In this report we highlight our experience with a COVID-19 patient who most likely suffered barotrauma either as a result of traumatic endotracheal intubation or primarily due to COVID-19 itself. We also aim to highlight the current literature available to suggest the management strategy for these patients for a favorable outcome. The cases described are diverse in terms of age variance and other comorbidities. According to the literature, certain patients, with COVID-19 disease and spontaneous pneumothorax were noted to be managed conservatively and oxygen supplementation with nasal cannula sufficed. Decision regarding need and escalation to invasive mechanical ventilation should be taken early in the disease to avoid complications such as patient self-inflicted lung injury (P-SILI) and barotrauma sequelae such as pneumothorax and pneumomediastinum Recent systematic review further supports the fact that the use of non-invasive ventilation (NIV) in certain patients with COVID-19 pneumonia may give a false sense of security and clinical stabilization but has no overall benefit to avoid intubation. While invasive mechanical ventilation may be associated with higher rates of barotrauma, this should not mean that intubation and invasive mechanical ventilation should be delayed. This becomes an important consideration when non-intensivists or personnel with less experience provide care for this vulnerable patient population who may rely too heavily on NIV to avoid intubation and mechanical ventilation.

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Section: Discussionmentioning

confidence: 91%

Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome

Lal

Mishra

Akhtar

et al. 2021

Monaldi Arch Chest Dis

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“…This formula correlates the length of the airway with the height to determine the length of ETT to acquire precise depth according to the criteria, namely 3-5 cm above the carina and 1.5-2.5 cm below the vocal cords. Research by Lal et al,(11) also mentioned that the ETT depth would linearly increase with the individual height. Likewise, this study also found that the addition of ETT depth correlates with body height.…”

Section: Resultsmentioning

confidence: 97%

“…In the study of Mukherjee et al, (9), the number of men was higher than women; however, this was not significant in the parameter test. Then, Lal et al, (11)'s study found a correlation between ETT depth and This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License height related to gender, yet it was not significant except in some extreme cases. Herway et al, (12) found a length difference of trachea, namely 0.7 cm longer for men.…”

Section: Resultsmentioning

confidence: 97%

Accuracy Comparison of Endotracheal Tube (ETT) Placement Using Chula Formula With Manubrium Sternal Joint (MSJ) Formula

Lorena

Hamzah

Maulydia

2021

IJAR

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Introduction: Intubation mistakes, such as ETT malposition, will result in serious complications. Endobronchial intubation can cause pneumothorax and contralateral lung collapse (atelectasis). On the contrary, superficial ETT could increase the risk of being released easily, leading to desaturation or even cardiac arrest. A shallow ETT position could cause the compression of the vocal cord and laryngeal nerve by ETT's cuff. An optimal position can be reached if the cuff position is 1.5-2.5 cm under the vocal cord and the tip is 3-5 cm above the carina. Several methods of ETT depth measurement based on airway length data can be an alternative, especially during the COVID-19 era, where the use of a stethoscope to check ETT depth is limited. Objectives: To analyze the accuracy of ETT depth placement using Chula and MSJ formula. Methods and Material: We conducted the prospective comparative analytic research on 50 patients who had elective surgery in GBPT operating room at Dr. Soetomo Hospital Surabaya. The research data during the intubation and FOL (Fyber Optic Laryngoscope) from each patient were height, MSJ length, initial ETT length, the distance of carina-ETT tip, the distance of cuff-vocal cord, and final ETT length. Result and Discussion: In the Chula formula group, the average patients' height was 160.60cm ± 9.738 for men and 157.76 cm ± 8.604 for women. The average MSJ length was 20.28 cm. The application of the Chula formula is more accurate because ETT revision was carried out in only 8.0% of the samples, with an average revision is 0.04. On the other hand, the ETT revision with an average of 0.868 on the MSJ formula group was conducted in 84% of the samples. This research also found a linear correlation between increasing ETT depth and body height. Conclusion: Applying the Chula formula to measure the ETT depth for Indonesian (Javanese) people is more appropriate than the MSJ formula.

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“…In their report dated 20 th March 2020, CDC mentions that 20% of the hospitalized patients and 12% of the intensive care patients from US belong to age range of 20 to 44 years (10). Amongst the comorbidities, hypertension, cardiovascular disorders, cerebrovascular disorders and diabetes are the top medical conditions who had more severe disease and required intensive care as compared to individuals without these comorbidities (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Specific subset of population like patients suffering from cancer, transplant recipients or other benign blood disorders need special attention for their underlying disease (17)(18)(19)(20).…”

Section: Demographic Details Of the Patientsmentioning

confidence: 99%

Trajectory of the COVID-19 pandemic: chasing a moving target

Sahu¹,

Mishra²,

Lal³

2020

Ann Transl Med

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The spread of COVID-19 has already taken a pandemic form, affecting over 180 countries in a matter of three months. The full continuum of disease ranges from mild, self-limiting illness to severe progressive COVID-19 pneumonia, multiorgan failure, cytokine storm and death. Younger and healthy population is now getting affected than before. Possibilities of airborne and fecal oral routes of transmission has increased the concern. In the absence of any specific therapeutic agent for coronavirus infections, the most effective manner to contain this pandemic is probably the non-pharmacological interventions (NPIs).The damage due to the pandemic disease is multifaceted and crippling to economy, trade, and health of the citizens of the countries. The extent of damage in such scenarios is something that is beyond calculation by Gross Domestic Product rate or currency value of the country. Unfortunately, unlike many other diseases, we are still away from the target antiviral drug and vaccine for severe acute respiratory syndrome (SARS-CoV-2) infection. The prime importance of NPIs like social distancing, staying in home, work from home, self-monitoring, public awareness, self-quarantine, etc. are constantly being emphasized by CDC, WHO, health ministries of all countries and social media houses. This is time of introspection and learning from our mistakes. Countries like China and South Korea who were initially the most hit countries could contain the disease spread by liberal testing of their population, stringent quarantine of people under investigation and isolation of the positive cases. Rest of the countries need to act urgently as well to bring an immediate halt in the community transmission.

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Ideal Length of Oral Endotracheal Tube for Critically Ill Intubated Patients in an Asian Population: Comparison to Current Western Standards

Cited by 7 publications

References 15 publications

Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome

Pneumothorax and pneumomediastinum in COVID-19 acute respiratory distress syndrome

Accuracy Comparison of Endotracheal Tube (ETT) Placement Using Chula Formula With Manubrium Sternal Joint (MSJ) Formula

Trajectory of the COVID-19 pandemic: chasing a moving target

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