Tube tip and cuff position using different strategies for placement of currently available paediatric tracheal tubes

Kemper, M.; Imach, Sebastian; Buehler, Philipp K.; Thomas, Jörg; Weiß, Markus

doi:10.1016/j.bja.2018.05.002

Cited by 21 publications

(24 citation statements)

References 23 publications

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“…Due to the fact that children have a short trachea, the cuffed tubes have a reduced safety limit of about 50%. When using a mesh ETT, the distal placement limit of the tracheal tube is in the carina, while the proximal cuffed border extends to the edge of the vocal cord [1,4,6,7,9]. In order to reduce the risk of subglottic damage caused by the cuffed tube and prevent side effects such as postextubation stridor, it is recommended that the uncuffed ETT be used in children under 8 years of age [1,7,9].…”

Section: Discussionmentioning

confidence: 99%

“…When using a mesh ETT, the distal placement limit of the tracheal tube is in the carina, while the proximal cuffed border extends to the edge of the vocal cord [1,4,6,7,9]. In order to reduce the risk of subglottic damage caused by the cuffed tube and prevent side effects such as postextubation stridor, it is recommended that the uncuffed ETT be used in children under 8 years of age [1,7,9]. Although there are many formulas in the use of uncuffed ETT, it can still be quite difficult to find a suitable diameter tube, and accordingly, multiple laryngoscopes or intubations can be used to change the tube causes [1,5].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, to reduce the risk of aspiration in laparoscopic surgery, to prevent multiple laryngoscopies and intubations, and for more accurate monitoring of tidal vol-ume and end-tidal carbon dioxide in ventilation, a cuffed ETT is also used [1,3]. However, the cricoid of the tracheal tubes poses a serious risk of airway damage in children due to the cuff being inserted between the subglottic region and the vocal cords and due to the fact that all pediatric cuffed tubes have the main design defects that can cause airway complications [4,[6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Baş

Kayhan

Onay

et al. 2020

BioMed Research International

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Aim. The aim of this study is to compare endotracheal tube leak, tube selection, mechanical ventilation, and side effects in the use of uncuffed tubes in both laparoscopic and laparotomy surgeries in pediatric patients. Material and Method. Patients who underwent laparotomy (LT group) or laparoscopic (LS group) surgery between 1 and 60 months. In the selection of uncuffed tubes, it was also planned to start endotracheal intubation with the largest uncuffed tube and to start intubation with a small uncuffed tube if the tube encounters resistance and does not pass. Mechanical parameters, endotracheal tube size, tube changes, and side effects are recorded. Results. A total of 102 patients, 38 females and 64 males, with a mean age of 10.9±8.1 months, body weight 7.1±3.7 kg, and height 67±15 cm, were included. 54 patients underwent laparoscopic surgery, and 48 patients underwent laparotomy. Tube exchange was performed in a total of 18 patients. In patients who underwent tube exchange, 11 patients were intubated with a smaller ETT number and others endotracheal intubation; when the MV parameters were TVe<8 ml/kg and ETT leak>20%, a larger uncuffed tube was used due to PIP 30 cmH2O pressure. Patients with aspiration were not found in the LT and LS groups. There was no difference in the intergroup evaluation for postoperative side effects such as cough, laryngospasm, stridor, and aspiration. Conclusion. There was no significant difference between the groups in terms of tube changes and side effects. So that we can start with the largest possible uncuffed tube to decrease ETT leak, both laparotomy and laparoscopic operations in children can be achieved with safe mechanical ventilation and target tidal volume.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Baş

Kayhan

Onay

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…Furthermore, only one brand of ETT was used in some of these reports. A recent report has tested several tube brands and insertion formulas including position of the cuff within the trachea [15]. The aim of this study is to create a formula for optimal depth of insertion of a pediatric cuffed ETT that includes both the upper and lower limits for the tube tip in the trachea.…”

Section: Introductionmentioning

confidence: 99%

Novel Formula for Calculation of the Optimal Insertion Depth for Cuffed Endotracheal Tubes in Pediatric Major Surgery

Kinoshita¹,

Hayase²,

Bando³

et al. 2019

OJAnes

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Background: Accurate determination of the optimal insertion depth of a pediatric endotracheal tube (ETT) is quite important. The aim of this study was to create an easily available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice. Methods: Eighty children under 12 years of age were enrolled. The depth marking of the cuffed ETT was placed at the vocal cords and both lungs were then auscultated using a stethoscope. The upper limit was radiographically defined as the position of the tip of the cuffed ETT being between the clavicles. The lower limit was defined as a distance of 5 mm above the carina. The relationship between the insertion depth and patient characteristics was analyzed to create a formula for optimal ETT insertion depth. Results: Sixty-nine ETTs were optimally placed in the trachea. There were good correlations between the optimal insertion depth of ETTs and patients characteristics (height (R = 0.92); BSA (R = 0.92); weight (R = 0.91); age (R = 0.88)). Using these patient characteristics, we created the following three formulas for calculation of the optimal insertion depth for pediatric cuffed ETTs: insertion depth (cm) = height (cm)/11 + 5.5, weight (kg)/3 + 9.5 or 11 + 3/4 × age (years). The rates of appropriate tube placement of both pediatric cuffed ETTs were 87.5% (Hi-Contour) and 85.0% (Microcuff). Conclusions: Our formula and graphs may be easy to determine the optimal insertion depth of cuffed ETT even without depth marking in clinical practice.

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“…1,2 In paediatric patients, it is important to place the tracheal tube correctly because of their shorter tracheal length compared with that in adults. 3 Suboptimal positioning of the tracheal tube occurs in 20e50% of such patients, and can trigger hypoxaemia, atelectasis, hypercarbia, barotrauma, pneumothorax, or even death. 4e8 The incidence of suboptimal positioning is two times higher in children younger than 2 yr of age than in those older than 2 yr. 6 Both chest radiography and fibreoptic bronchoscopy objectively and accurately confirm optimal depth of the tracheal tube.…”

mentioning

confidence: 99%

Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children

Ahn

Kwon

Lee

et al. 2019

British Journal of Anaesthesia

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Background: The tip of the tracheal tube should lie at the mid-tracheal level after tracheal intubation in paediatric patients. Auscultation does not guarantee optimal positioning of the tracheal tube. We compared auscultation and the ultrasound-guided lung sliding sign to confirm optimal positioning of the tracheal tube in paediatric patients. Methods: We studied 74 paediatric patients aged 0e24 months of ASA physical status 1e3 who were scheduled for elective surgery under general anaesthesia. All were randomly assigned to one of two groups: depth of tracheal tube confirmed by auscultation (Group A) or using the ultrasound-guided lung sliding sign (Group S). Results: Optimal positioning of the tracheal tube was observed in 32 of 37 (87%) subjects in Group S and 24 of 37 (65%) subjects in Group A (difference in proportion, 22%; 95% confidence interval, 2e39%; P¼0.030). Optimal depth correlated with patient height (adjusted coefficient¼0.888, P<0.001). Conclusions: In paediatric patients younger than 24 months, use of the ultrasound-guided lung sliding sign was more accurate than auscultation for optimal positioning of the tracheal tube. Clinical trial registration: KCT 0003015.

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Tube tip and cuff position using different strategies for placement of currently available paediatric tracheal tubes

Cited by 21 publications

References 23 publications

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries

Novel Formula for Calculation of the Optimal Insertion Depth for Cuffed Endotracheal Tubes in Pediatric Major Surgery

Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children

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