The design of pediatric tracheal tubes

Abstract

SummaryDifferences in the anatomy and physiology of the young child necessitate specialist equipment and anesthetic equipment is constantly evolving. We will review the factors influencing the design of pediatric tubes and highlight those areas of special interest. There have been pleas for more standardization of tube markings, as this would help with positioning of tubes, especially in small babies, and there are recent advances in this area. Anesthetists need to be aware that there are important differences between tubes so that they take this into account when choosing an appropriate tube. In addition, developments in the design of cuffed tubes are increasingly being used both for routine care and specialist surgery.

Unrecognized bronchial intubation associated with the uncuffed pediatric tracheal tube with bilateral Murphy eyes

“…Reliability of the auscultatory method using a conventional stethoscope depends on the shape of the distal tip of the tracheal tube, especially the presence of the Murphy eye . Many pediatric tubes have a Murphy eye . Although a Murphy eye located on the side of the tube opposite to the bevel allows lung ventilation even if the bevel is occluded by a mucus plug or sealed by contact with the tracheal wall , it has the disadvantage of reducing the reliability of chest auscultation in detecting bronchial intubation .…”

“…Many pediatric tubes have a Murphy eye . Although a Murphy eye located on the side of the tube opposite to the bevel allows lung ventilation even if the bevel is occluded by a mucus plug or sealed by contact with the tracheal wall , it has the disadvantage of reducing the reliability of chest auscultation in detecting bronchial intubation .…”

“…In head and neck surgery, preformed tracheal tubes are available that decrease the risk of tube kinking and accidental extubation . Several uncuffed preformed pediatric tracheal tubes have an additional eye above the bevel, which allows the left lung to be ventilated when the tube tip is inserted deeply into the right main stem bronchus.…”

Distances from vocal cords to mid‐trachea for optimizing endotracheal tubes depth markers according to gestational age

“…Distances from ETT tip to marker line vary considerably between brands and even between tubes from the same company: Distances ranging from 15 to 28 mm were reported in uncuffed 2.5 mm ETT. [6][7][8][9] This variability is a potential cause of hazard when working with different ETT brands 10,11 or in transport.…”

Editorial

“…Assessment of the pediatric airway is largely clinical for most cases (1) but modern imaging can give stunningly clear information as illustrated in the second article by Eslamy and Newman (2). Anatomy also affects equipment design, both for visualizing the airway (3,4) and also for securing the airway (5). A myriad of airway devices are now available for elective (6) and emergency use (7) and these are critically reviewed in this issue.…”