Poor performance of the pediatric airway exchange catheter in adults with cervical spine immobilization

Abstract

Purpose: Use of a pediatric airway exchange catheter (PAEC) has been advocated as a potentially useful adjunct for difficult extubations. We evaluated the laryngeal passing ability of a tracheal tube over a PAEC and compared its success rate between adult patients in the sniffing position and adult patients with simulated cervical spine immobilization created using a manual in-line axial stabilization (MIAS) technique. Methods:A total of 100 adult patients were randomized into two groups of equal size with respect to position during the simulated reintubation trial: the MIAS position (Group M) and the sniffing position (Group S). After induction of anesthesia, an 11-F PAEC was placed in the trachea under direct laryngoscopic view, and a wire-reinforced tube (with its bevel facing to the left) was gently railroaded over the PAEC and into the trachea. If insertion was impeded, a second attempt was made after rotating the tube 90° counterclockwise. If this also failed, one additional attempt was made using external laryngeal pressure before changing to conventional laryngoscopic intubation. Results:After the second attempt, the cumulative success rates in Groups M and S were 41.3% and 72.3%, respectively (P = 0.003). After three attempts, the overall success rate was significantly lower in Group M (52.2%) than in Group S (76.6%) (P = 0.018). Conclusion:Owing to the high failure rate of PAEC-guided intubation in patients with simulated cervical spine immobilization, use of a PAEC is not recommended for maintaining continuous airway access after extubation in adult patients with cervical immobility or instability. 41,3 % et 72,3 %, respectivement (P = 0,003 Méthode : Au total, 100 patients adultes ont été randomisés en deux groupes de taille égale selon leur position pendant l'essai de réintubation simulée : la position MIAS (groupe M) et la position de reniflement (groupe S). Après l'induction de l'anesthésie, une PAEC 11-F a été placé dans la trachée sous vision laryngoscopique di-

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

“…This is more likely to occur when patients are in a neutral head‐neck position (e.g. manual in‐line neck stabilisation) compared with the ‘sniffing’ position . The Parker Flex‐Tip ™ tracheal tube (Parker Medical, Englewood, CO, USA) has a curved tip and posterior‐facing bevel, which minimises this gap and allows smooth passage into the trachea .…”