The Tracheal Accordion and the Position of the Endotracheal Tube

Herway, Seth T.; Benumof, Jonathan L.

doi:10.1177/0310057x1704500207

Cited by 22 publications

(27 citation statements)

References 72 publications

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“…For the prevention of deep tube malposition, the recommended insertion depths of tracheal tubes for achieving an acceptable TCD are 20-21 cm in women and 22-23 cm in men, although special circumstances (head and neck movements during interventions) and stature (eg, short neck anatomy) always require individual considerations. 16 22 23 Although we did not document tube insertion lengths at ED admission in the current study, we recommend its documentation in the charts. Moreover, a standardised assessment including all relevant parameters of emergency airway management is strongly recommended in order to provide comparability in future studies.…”

Section: Avoidable Tube Thoracostomymentioning

confidence: 88%

Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients

et al. 2021

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BackgroundEmergency tracheal intubation during major trauma resuscitation may be associated with unrecognised endobronchial intubation. The risk factors and outcomes associated with this issue have not previously been fully defined.MethodsWe retrospectively analysed adult patients admitted directly from the scene to the ED of a single level 1 trauma centre, who received either prehospital or ED tracheal intubation prior to initial whole-body CT from January 2008 to December 2019. Our objectives were to describe tube-to-carina distances (TCDs) via CT and to assess the risk factors and outcomes (mortality, length of intensive care unit stay and mechanical ventilation) of patients with endobronchial intubation (TCD <0 cm) using a multivariable model.ResultsWe included 616 patients and discovered 26 (4.2%) cases of endobronchial intubation identified on CT. Factors associated with an increased risk of endobronchial intubations were short body height (OR per 1 cm increase 0.89; 95% CI 0.84 to 0.94; p≤0.001), a high body mass index (OR 1.14; 95% CI 1.04 to 1.25; p=0.005) and ED intubation (OR 3.62; 95% CI 1.39 to 8.90; p=0.006). Eight of 26 cases underwent tube thoracostomy, four of whom had no evidence of underlying chest injury on CT. There was no statistically significant difference in mortality or length of stay although the absolute number of endobronchial intubations was small.ConclusionsShort body height and high body mass index were associated with endobronchial intubation. Before considering tube thoracostomy in intubated major trauma patients suspected of pneumothorax, the possibility of unrecognised endobronchial intubation should be considered.

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Section: Avoidable Tube Thoracostomymentioning

confidence: 88%

Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients

et al. 2021

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“…Then, Lal et al, (11)'s study found a correlation between ETT depth and This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License height related to gender, yet it was not significant except in some extreme cases. Herway et al, (12) found a length difference of trachea, namely 0.7 cm longer for men. Research conducted by Fatma, (13) on body anthropometry found that men have a higher body posture than women.…”

Section: Resultsmentioning

confidence: 92%

Accuracy Comparison of Endotracheal Tube (ETT) Placement Using Chula Formula With Manubrium Sternal Joint (MSJ) Formula

Lorena

Hamzah

Maulydia

2021

IJAR

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Introduction: Intubation mistakes, such as ETT malposition, will result in serious complications. Endobronchial intubation can cause pneumothorax and contralateral lung collapse (atelectasis). On the contrary, superficial ETT could increase the risk of being released easily, leading to desaturation or even cardiac arrest. A shallow ETT position could cause the compression of the vocal cord and laryngeal nerve by ETT's cuff. An optimal position can be reached if the cuff position is 1.5-2.5 cm under the vocal cord and the tip is 3-5 cm above the carina. Several methods of ETT depth measurement based on airway length data can be an alternative, especially during the COVID-19 era, where the use of a stethoscope to check ETT depth is limited. Objectives: To analyze the accuracy of ETT depth placement using Chula and MSJ formula. Methods and Material: We conducted the prospective comparative analytic research on 50 patients who had elective surgery in GBPT operating room at Dr. Soetomo Hospital Surabaya. The research data during the intubation and FOL (Fyber Optic Laryngoscope) from each patient were height, MSJ length, initial ETT length, the distance of carina-ETT tip, the distance of cuff-vocal cord, and final ETT length. Result and Discussion: In the Chula formula group, the average patients' height was 160.60cm ± 9.738 for men and 157.76 cm ± 8.604 for women. The average MSJ length was 20.28 cm. The application of the Chula formula is more accurate because ETT revision was carried out in only 8.0% of the samples, with an average revision is 0.04. On the other hand, the ETT revision with an average of 0.868 on the MSJ formula group was conducted in 84% of the samples. This research also found a linear correlation between increasing ETT depth and body height. Conclusion: Applying the Chula formula to measure the ETT depth for Indonesian (Javanese) people is more appropriate than the MSJ formula.

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“…Cardiac and pulmonary diseases may cause changes in tracheal anatomy, as well as goiter, smoking and aging [1,3]. In addition to anatomical changes, there are dynamic changes of the tracheal following anesthesia and relaxation [4]. Tracheal anatomy has great importance in procedures as tracheal intubation and ventilation [5,6].…”

Section: Introductionmentioning

confidence: 99%

The Frequency of Acquired and Age-Related Tracheal Deformations: a Retrospective Study of CT Scan Findings

Edward¹,

Rudolf²,

Simona³

et al. 2019

Anesth Crit Care

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Background: Changes of the anatomy of the trachea occur during aging and as a result of a large goiter, cardiac or pulmonary diseases and smoking. These changes may cause difficulties in endotracheal intubation. Methods:In this retrospective study, we analyzed the frequency of acquired deformations, as seen in chest CT scan of 200 adult patients. The radiographic findings were studied, as well as the patients' demographic variables and comorbidities.Results: Acquired deformation of the trachea was found only in patients that were older than 50 years. In 117 patients 50 to 90 year-old three types of deformations were found: "S-shape" trachea in 83 patients (71%), horizontal left main bronchus with wide angle main carina in 24 patients (20.5%) and saber-sheath trachea in 10 patients (8.5%).Conclusions: Acquired deformation of the trachea is frequent in patients older than 50. Studying the patient's chest CT scan may assist the physician in performing endotracheal intubation cautiously and safely.

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The Tracheal Accordion and the Position of the Endotracheal Tube

Cited by 22 publications

References 72 publications

Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients

Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients

Accuracy Comparison of Endotracheal Tube (ETT) Placement Using Chula Formula With Manubrium Sternal Joint (MSJ) Formula

The Frequency of Acquired and Age-Related Tracheal Deformations: a Retrospective Study of CT Scan Findings

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