Does body mass index predict tracheal airway size?

D’Anza, Brian; Knight, Jesse; Greene, J. Scott

doi:10.1002/lary.24943

Cited by 37 publications

(33 citation statements)

References 15 publications

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“…One may argue that clinicians would not use a size 8.0 ETT in patients with 1.6 or 2.4 cm tracheas. However, patients are not routinely scanned to assess tracheal size prior to intubation and studies have shown the inaccuracies in clinicians assessing tracheal size [30]. Using a size 8.0 ETT in this range of trachea sizes, represents rigorous bench testing and better comparison to clinical practice and anatomical variation.…”

Section: Discussionmentioning

confidence: 99%

“…The wrong size can cause tracheal ischemia (if too large) or facilitate aspiration (if too small) [29]. A recent study identified an inverse relationship between tracheal size and body mass index [30], highlighting potential difficulties in making accurate assessments. Therefore, ETTs need to account for anatomical variation and safeguard the trachea.…”

Section: Introductionmentioning

confidence: 99%

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Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies

et al. 2017

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BackgroundAspiration of subglottic secretions past the endotracheal tube (ETT) cuff is a prerequisite for developing ventilator-associated pneumonia (VAP). Subglottic secretion drainage (SSD) ETTs reduce aspiration of subglottic secretions and have demonstrated lower VAP rates. We compared the performance of seven SSD ETTs against a non-SSD ETT in preventing aspiration below inflated cuffs.MethodsETTs were positioned vertically in 2 cm diameter cylinders. Four ml of a standard microbial suspension was added above inflated cuffs. After 1 h, aspiration was measured and ETTs demonstrating no leakage were subjected to rotational movement and evaluation over 24 h. Collected aspirated fluid was used to inoculate agar media and incubated aerobically at 37 °C for 24 h. The aspiration rate, volume and number of microorganisms that leaked past the cuff was measured. Experiments were repeated (×10) for each type of ETT, with new ETTs used for each repeat. Best performing ETTs were then tested in five different cylinder diameters (1.6, 1.8, 2.0, 2.2 and 2.4 cm). Experiments were repeated as above using sterile water. Volume and time taken for aspiration past the cuff was measured. Experiments were repeated (×10) for each type of ETT. Results were analysed using non-parametric tests for repeated measures.ResultsThe PneuX ETT prevented aspiration past the cuff in all experiments. All other ETTs allowed aspiration, with considerable variability in performance. The PneuX ETT was statistically superior in reducing aspiration compared to the SealGuard (p < 0.009), KimVent (p < 0.002), TaperGuard (p < 0.004), Lanz (p < 0.001), ISIS (p < 0.001), SACETT (p < 0.001) and Soft Seal (p < 0.001) ETTs. Of the 4 ETTs tested in differing cylinder sizes, the PneuX significantly reduced aspiration across the range of diameters compared to the SealGuard (p < 0.0001), TaperGuard (p < 0.0001) and KimVent (p < 0.0001) ETTs.ConclusionsETTs showed substantial variation in fluid aspiration, relating to cuff material and design. Variability in performance was likely due to the random manner in which involutional folds form in the inflated ETT cuff. The PneuX ETT was the only ETT able to consistently prevent aspiration past the cuff in all experiments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies

et al. 2017

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“…Literature addressing extrinsic factors demonstrates that ETT size selection in male patients should consider height as a predictive measure of tracheal size rather than BMI (26 – 27). To this point, D’Anza showed a trend of smaller airways with increasing BMI and concluded that avoiding larger tubes in obese patients would reduce airway injury (27). Halum et al .…”

Section: Discussionmentioning

confidence: 99%

Predictors of Posterior Glottic Stenosis

Hillel

Karataylı-Özgürsoy

Samad

et al. 2015

Ann Otol Rhinol Laryngol

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Objective To assess intrinsic and extrinsic risk factors in the development of posterior glottic stenosis (PGS) in intubated patients. Methods PGS patients diagnosed between September 2012 – May 2014 at three tertiary care university hospitals were included. Patient demographics, comorbidities, duration of intubation, ETT size, and indication for intubation were recorded. PGS patients were compared to control patients represented by patients intubated in intensive care units (ICU). Results Thirty-six PGS patients were identified. After exclusion, 28 PGS patients (14 male, 14 female) and 112 (65 male, 47 female) controls were studied. Multivariate analysis demonstrated ischemia (p<0.05), diabetes (p<0.01), length of intubation (p<0.01) were significant risk factors for the development of PGS. 14/14 (100%) males were intubated with a size 8 or larger ETT compared to 47/65 (72.3%) male controls (p<0.05). PGS (p<0.01), length of intubation (p<0.001), and obstructive sleep apnea (p<0.05) were significant risk factors for tracheostomy. Conclusion Duration of intubation, ischemia, diabetes mellitus, and large ETT size (8 or greater) in males were significant risk factors for the development of PGS. Reducing the use of size 8 ETTs and earlier planned tracheostomy in high-risk patients may reduce the incidence of PGS and improve ICU safety.

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“…El peso ideal debe utilizarse para calcular el tamaño de los tubos orotraqueales y el volumen corriente durante la ventilación controlada. El diámetro traqueal se reduce ligeramente con el aumento de índice de masa corporal 27 . Ningún modo particular de ventilación controlada ha demostrado ser superior en pacientes obesos, sin embargo, mayores volúmenes corrientes para una presión máxima determinada pueden lograrse utilizando la ventilación controlada por presión, en vez de por volumen 3 .…”

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Consideraciones perioperatorias en el paciente obeso

et al. 2018

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Obesity is a condition of excessive accumulation of body fat to a level that is harmful to health. The prevalence of obesity is increasing worldwide at an alarming rate. Therefore it is essential to know the perioperative management and specific considerations in this population. The majority of obese patients who undergo surgical procedures have few additional pathology, so their perioperative risk is similar to eutrophic patients. Obesity Surgery Mortality Risk Stratification Score OS-MRS is a validated scale for assessing the risk of perioperative mortality in these patients. It is essential to look for the presence of respiratory sleep disorders in these patients, and for this purpose, the STOP-BANG questionnaire is the most valid today. During anesthetic induction it is recommended to place the patient in the "ramp" position as it significantly improves the visualization of the glottis during laryngoscopy. Also, this position optimizes the oxygenation and ventilatory mechanics of these patients, increasing the time of safe apnea. Regarding airway management, orotracheal intubation with controlled ventilation is the technique of choice in this population. Anesthetic drug doses should be calculated based on adjusted weight or lean weight, depending on the type of drug chosen. Finally, complete and frequent postoperative monitoring is recommended in the recovery unit, transferring these patients to their room only when they meet the criteria included in the White and Song scale.

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Does body mass index predict tracheal airway size?

Abstract: 4 Laryngoscope, 125:1093-1097, 2015.

Cited by 37 publications

References 15 publications

Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies

Endotracheal tubes and fluid aspiration: an in vitro evaluation of new cuff technologies

Predictors of Posterior Glottic Stenosis

Consideraciones perioperatorias en el paciente obeso

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