Comparison of two topographical airway length measurements in adults

Abstract

BackgroundA correct estimate of the tracheal tube insertion depth can prevent complications, including endobronchial intubation and vocal cord trauma. We evaluated a new topographical method for endotracheal tube positioning relative to the carina, using a well-known prior topographical method for comparison.MethodsOne hundred adult (male 50, female 50) patients were studied. The comparison topographic length (in cm) was measured by adding the distance between the right mouth corner and the right mandibular angle to the distance between the right mandibular angle and the center of the sternal manubrium. The new endotracheal tube insertion depth (in cm) was determined by adding the distance between the right mouth corner and the vocal cords, measured with the endotracheal tube itself, to the distance between the thyroid prominence and the manubriosternal joint, and then subtracting 4 cm. After intubation, the endotracheal tube was positioned properly at the right mouth corner and the endotracheal tube tip was evaluated using a fiberoptic bronchoscope at the carina.ResultsThe distances from the tip of the endotracheal tube to the carina were not significantly different between the methods in the same gender. However, our method allowed endotracheal tube tip placement between 3 cm and 5 cm, above the carina more frequently than the prior method in males.ConclusionsThe new topographical method can be used as a guide to positioning the endotracheal tubes.

Accuracy in placing oral cuffed endotracheal tube to correct depth in Indian adults based on conventional guidelines

“…2 The incorrect placement of an endotracheal tube can lead to serious complications including endobronchial intubation, vocal cord paralysis, accidental extubation, collapsed lung, hypoxaemia and pulmonary barotrauma. 3,4 Black mark(s) if provided proximal to the cuff and kept at level with cords aids in assessing correct depth of ETT placement to avoid the above complications. Several methods are available to confirm the intratracheal ETT placement at the bed side, however, although these tests can exclude oesophageal intubation, they cannot accurately declare how far an ETT is positioned within the trachea.…”

Estimation of the optimum length of endotracheal tube insertion in adults

“…1,2 Endobronchial intubation is the most common critical incident that can cause arterial desaturation during orotracheal intubation. According to the ASA Closed Claims Project, selective intubation accounts for 2% of adverse respiratory events in adults, 3 and considering the more serious or fatal consequences of these events, including cerebral damage in up to 85% of patients, 4 the correct placement of the tip of the endotracheal tube is a vital element in the practice of anesthesiology and emergency and critical care medicine.…”

“…However, these methods are not always based on evidence, nor are they always cost effective or applicable to every scenario of a given situation. 1 Some authors have found that in 28% of patients with cardiac arrest, intubated by staff trained in advanced life support, the tip of the tube was endobronchial. 6,7 Using the traditional insertion method of the endotracheal tube of 21 and 23 cm in women and men respectively as proposed in the literature several years ago, 8 some publications show figures of more than 33.4% of endotracheal tubes incorrectly placed, 9,10 this being a more frequent adverse event in women than in men (61.9% vs 38.1%).…”