Tracheal Size Variability Is Associated With Sex

Karmakar, Arunabha; Pate, Mariah B.; Solowski, Nancy; Postma, Gregory N.; Weinberger, Paul M.

doi:10.1177/0003489414549154

Cited by 30 publications

(32 citation statements)

References 25 publications

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“…The anterior-posterior (AP) tracheal diameter ranges between 1.27-2.38 cm for women and 1.68-2.86 cm for men [28]. Selecting the correct size ETT for patients is subjective and determined on the patient’s sex, height or weight [29]. The wrong size can cause tracheal ischemia (if too large) or facilitate aspiration (if too small) [29].…”

Section: Introductionmentioning

confidence: 99%

“…Selecting the correct size ETT for patients is subjective and determined on the patient’s sex, height or weight [29]. 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.…”

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: Introductionmentioning

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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“…Multiple studies have utilized CT scans to evaluate the upper airway anatomy and its relevance to the demographic factors; however, these studies used MCM for CSA measurements [8-9, 15]. Since MCM assumes that the airways take a regular oval shape, we questioned the accuracy of such measurements based on the actual irregularity of the upper airway segments, the semi-triangular shape of the glottic and proximal subglottic areas, and the indentation of the posterior wall of the trachea with inspiration.…”

Section: Discussionmentioning

confidence: 99%

“…The anteroposterior diameter (APD) and transverse diameter (TD) are easily measured by any CT software. The cross-sectional area (CSA) is calculated mathematically from the APD and TD, assuming that the upper airway segments take an oval configuration [8-9]. The software calculation method (SCM) measures the CSA directly using the inbuilt software by drawing a perimeter manually around the area of interest and counting each pixel inside that area.…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Mathematical and Software Calculation Methods for the Measurement of the Cross-sectional Area in Upper Airway Imaging

Aljathlany

AlAmari

Aljasser

et al. 2019

Cureus

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ObjectivesThis study aimed to compare the results of a software calculation method (SCM) and the mathematical calculation method (MCM) in measuring the cross-sectional area (CSA) at four different upper airway segments.MethodsThe data from the retrospective chart reviews of patients older than 18 years who had undergone computed tomography (CT) of the neck at our tertiary care center between September 2014 and September 2018 were reviewed. Data of patients who were intubated, tracheostomized, had nasogastric tubes, tumors, craniofacial anomalies, trauma, or any pathology that may affect the normal airway anatomy were excluded. We measured the anteroposterior (APD) and transverse diameter (TD) utilizing the CT software. CSA was calculated using both the mathematical formula (MCM) and software (SCM) at the glottis, proximal subglottis, distal subglottis, and tracheal levels. A paired sample t-test was used to determine the significant difference between SCM and MCM at each level.ResultsThe data of 100 patients (59% female) were reviewed. There was a significant difference between the SCM and MCM at all four levels. The mean differences between the SCM and MCM were -33.63 mm2, -24.20 mm2, 6.04 mm2 (p < 0.001) at the glottis, proximal subglottis, and trachea, respectively. The mean difference at the distal subglottis was -4.08 mm2 (p = 0.01).ConclusionOur study found a significant difference between the SCM and MCM in measuring the CSA of the four airway segments. Theoretically, the SCM is more accurate and precise than MCM in measuring CSA; however, we could not prove the superiority of either method.

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“…7.0–8.0 for men, while an I.D. 6.5–7.0 for women34. A multicenter study35 showed that 22.7% obese patients intubated with a tracheal tube >7.5 mm developed tracheal stenosis, compared with 3.3% of those with a tube size ≤7.5 mm, indicating the correlation between tube size and postintubation tracheal stenosis.…”

Section: Discussionmentioning

confidence: 99%

A canine model of tracheal stenosis induced by cuffed endotracheal intubation

Zhou

et al. 2017

Sci Rep

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Postintubation tracheal stenosis is a complication of endotracheal intubation. The pathological mechanism and risk factors for endotracheal intubation-induced tracheal stenosis remain not fully understood. We aimed to establish an animal model and to investigate risk factors for postintubation tracheal stenosis. Beagles were intubated with 4 sized tubes (internal diameter 6.5 to 8.0 mm) and cuff pressures of 100 to 200 mmHg for 24 hr. The status of tracheal wall was evaluated by bronchoscopic and histological examinations. The model was successfully established by cuffed endotracheal intubation using an 8.0 mm tube and an intra-cuff pressure of 200 mmHg for 24 hr. When the intra-cuff pressures were kept constant, a larger sized tube would induce a larger tracheal wall pressure and more severe injury to the tracheal wall. The degree of tracheal stenosis ranged from 78% to 91% at 2 weeks postextubation. Histological examination demonstrated submucosal infiltration of inflammatory cells, hyperplasia of granulation tissue and collapse of tracheal cartilage. In summary, a novel animal model of tracheal stenosis was established by cuffed endotracheal intubation, whose histopathological feathers are similar to those of clinical cases of postintubation tracheal stenosis. Excessive cuff pressure and over-sized tube are the risk factors for postintubation tracheal stenosis.

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Tracheal Size Variability Is Associated With Sex

Abstract: Our data suggest that selection of ETT size in male patients should include height as a predictive factor. For female patients, it may be appropriate to select a uniformly smaller diameter ETT size.

Cited by 30 publications

References 25 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

Comparison Between Mathematical and Software Calculation Methods for the Measurement of the Cross-sectional Area in Upper Airway Imaging

A canine model of tracheal stenosis induced by cuffed endotracheal intubation

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