Laryngeal damage from tracheal intubation

Holzki, Josef

doi:10.1046/j.1460-9592.1997.d01-127.x

Cited by 59 publications

(47 citation statements)

References 1 publication

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“…Depth markings should be compared with those of the next size uncuffed tracheal tube. 12 (5) Manufacturers should revise the design of their cuffed tubes in accordance to age-related anatomical measurements in particular regarding height of the cuff position and depth markings.…”

Section: éLéments Cliniques : Un Enfant De 13 Mois Devant Subir Une Imentioning

confidence: 99%

“…[1][2][3] The advantages mentioned are improved efficiency of ventilation, reduced atmospheric pollution, more reliable end-tidal CO 2 monitoring, ability to use low flow anesthesia, reduced need to replace an ill-fitting tracheal tube and a decreased use of too large uncuffed tubes, the main reason for subglottic stenosis. 4,5 However, serious concerns have been raised regarding inadvertent cuff hyperinflation causing airway damage with the risk of post-extubation morbidity (stridor, subglottic stenosis). [5][6][7] We report a case of laryngeal damage in a child due to a too large and inadequately designed cuffed tracheal tube.…”

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confidence: 99%

“…4,5 However, serious concerns have been raised regarding inadvertent cuff hyperinflation causing airway damage with the risk of post-extubation morbidity (stridor, subglottic stenosis). [5][6][7] We report a case of laryngeal damage in a child due to a too large and inadequately designed cuffed tracheal tube.…”

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Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child

Dillier

Trachsel²,

Baulig

et al. 2004

Can J Anesth/J Can Anesth

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Section: éLéments Cliniques : Un Enfant De 13 Mois Devant Subir Une Imentioning

confidence: 99%

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confidence: 99%

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Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child

Dillier

Trachsel²,

Baulig

et al. 2004

Can J Anesth/J Can Anesth

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“…However, one concern when using cuffed paediatric tracheal tubes in smaller children is that damage may be caused to laryngeal and tracheal mucosa, resulting in oedema, post-extubation morbidity (post-extubation stridor, subglottic stenosis), ulceration or circular necrosis [2,9].…”

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confidence: 99%

An in vitro study of the compliance of paediatric tracheal tube cuffs and tracheal wall pressure

Bernet¹,

Dullenkopf

Cannizzaro³

et al. 2006

Anaesthesia

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SummaryCuff volume-pressure curves and cuff pressure-tracheal wall pressure relationships were investigated in eight brands of currently available cuffed, paediatric tracheal tubes with internal diameters of 5.0 mm. Cuff volume-pressure curves were measured with the cuff unrestricted and with the cuff placed within a tracheal model with wall pressure measurements. With the tracheal tube cuffs, unrestricted cuff compliance at 20 cmH 2 O cuff pressure varied between 0.06 and 0.3 ml.cmH 2 O )1 . With the cuff restricted within the model trachea, all tracheal tube cuffs became considerably less compliant (0.01-0.09 ml.cmH 2 O )1 ). We found tracheal wall pressure was similar to the cuff pressure as long as the resulting cuff diameter was sufficiently large freely to drape the inner tracheal wall. We found that, regardless of whether a higher or lower compliant tube cuff was used, cuff hyperinflation uniformly resulted in potentially compromised tracheal mucosal blood flow; cuff pressure monitoring using cuff pressure limitation is therefore strongly recommended.

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“…However, overinflation of tracheal tube cuffs is a known risk factor in producing airway morbidity and complications due to cuff pressure and volume increases, asymmetric cuff expansion, and possible herniation of the distal cuff producing airway obstruction [6][7][8]. Severe airway damage may occur especially if the cuff is inadvertently placed within the paediatric larynx [9,10].A wide variety of cuff sizes, differences in compliance, and a variety of materials are used to construct cuff membranes in paediatric tracheal tubes [11][12][13][14]. So far, expansion characteristics of different cuffs at higher cuff pressure levels have not been investigated.…”

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confidence: 99%

Outer diameter and shape of paediatric tracheal tube cuffs at higher inflation pressures

Bernet¹,

Dullenkopf

Maino

et al. 2005

Anaesthesia

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SummaryCuffed tracheal tubes are becoming increasingly popular in paediatric anaesthesia and intensive care medicine. To avoid cuff related complications and airway morbidity, a thorough understanding of cuff volume ⁄ pressure behaviour and management is required. In this study, the outer cuff diameter and form stability of the cuff at high cuff pressure were assessed in a series of different paediatric cuffed tracheal tubes with internal diameter of between 3.0 and 5.0 mm. The main findings were that small amounts of inflated air led to a rapid increase in cuff pressure and volume and that the outer cuff diameters increased to 2-2.5 times the age-corresponding internal tracheal diameter following inadvertent syringe inflation. Careful cuff inflation under cuff pressure monitoring and ⁄ or automatic cuff pressure release is recommended in paediatric tracheal tube cuffs to prevent airway damage caused by manual inflation, pilot balloon compression and nitrous oxide diffusion. The use of cuffed tracheal tubes in small children is becoming increasingly popular in paediatric anaesthesia and intensive care medicine [1][2][3][4][5]. However, overinflation of tracheal tube cuffs is a known risk factor in producing airway morbidity and complications due to cuff pressure and volume increases, asymmetric cuff expansion, and possible herniation of the distal cuff producing airway obstruction [6][7][8]. Severe airway damage may occur especially if the cuff is inadvertently placed within the paediatric larynx [9,10].A wide variety of cuff sizes, differences in compliance, and a variety of materials are used to construct cuff membranes in paediatric tracheal tubes [11][12][13][14]. So far, expansion characteristics of different cuffs at higher cuff pressure levels have not been investigated. The aim of this study was to evaluate changes in outer cuff diameter, stability of cuffs and the risk of cuff herniation in currently available paediatric tracheal tube cuffs at higher cuff pressures. MethodsIn an in vitro study, eight types of currently available paediatric cuffed tracheal tubes with internal diameters (ID) of 3.0 mm and 5.0 mm from five different manufacturers (Table 1) were studied.Assessment of outer cuff diameters was performed using a sliding calliper. The pilot balloons of the tested tube cuffs were connected to a cuff pressure manometer (Cuff pressure controller; Mallinckrodt, Athlone, Ireland) using a three-way tap.Cuff pressure was set to 20 cmH 2 O and was increased in steps of 10 cmH 2 0 up to a maximum of 120 cmH 2 O by inflating with air from a syringe connected via the three-way tap. At each level, the largest outer cuff diameter was measured. In addition, measurements were made after simulating inadvertent cuff hyperinflation by means of an air-filled 5-ml and 10-ml syringe in ID 3.0 mm, and ID 5.0 mm tracheal tubes, respectively.The volume of air required to achieve a cuff pressure of 20, 60 and 120 cmH 2 O was assessed. Experiments were performed using the cuff manometer-syringe assembly described above ...

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Laryngeal damage from tracheal intubation

Cited by 59 publications

References 1 publication

Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child

Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child

An in vitro study of the compliance of paediatric tracheal tube cuffs and tracheal wall pressure

Outer diameter and shape of paediatric tracheal tube cuffs at higher inflation pressures

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