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Assessment of three placement techniques for individualized positioning of the tip of the tracheal tube in children under the age of 4 years.
Paediatr Anaesth. 2015 Apr; 25(4):379-85.PA

Abstract

BACKGROUND

Accurate positioning of the tip of the tracheal tube (tube tip) is challenging in young children. Prevalent clinical methods include placement of intubation depth marks, palpation of the tube cuff in the suprasternal notch, or deliberate mainstem intubation with subsequent withdrawal. To compare the predictability of tube tip positions, variability of the resulting positions in relation to the carina was determined applying the three techniques in each patient.

METHODS

In 68 healthy children aged ≤4 years, intubation was performed with an age-adapted, high-volume low-pressure cuffed tube adjusting the imprinted depth mark to the level of the vocal cords. The tube tip-to-carina distance was measured endoscopically. Thereafter, placements using (I) cuff palpation in the suprasternal notch and (II) auscultation to determine change in breath sounds during withdrawal after bronchial mainstem intubation were completed in random order.

RESULTS

Tube tip position above the carina was higher when using depth marks (mean = 36.8 mm) compared with cuff palpation in the suprasternal notch (mean = 19.0 mm). Variability, expressed as sd, was lowest with the mainstem intubation technique (5.2 mm) followed by the cuff palpation (7.4 mm) and the depth mark technique (11.2 mm) (P < 0.005).

CONCLUSION

Auscultation after deliberate mainstem intubation and cuff palpation resulted in a tube tip position above the carina that was shorter and more predictable than placement of the tube using depth markings.

Authors+Show Affiliations

Department of Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25308697

Citation

Moll, Jens, et al. "Assessment of Three Placement Techniques for Individualized Positioning of the Tip of the Tracheal Tube in Children Under the Age of 4 Years." Paediatric Anaesthesia, vol. 25, no. 4, 2015, pp. 379-85.
Moll J, Erb TO, Frei FJ. Assessment of three placement techniques for individualized positioning of the tip of the tracheal tube in children under the age of 4 years. Paediatr Anaesth. 2015;25(4):379-85.
Moll, J., Erb, T. O., & Frei, F. J. (2015). Assessment of three placement techniques for individualized positioning of the tip of the tracheal tube in children under the age of 4 years. Paediatric Anaesthesia, 25(4), 379-85. https://doi.org/10.1111/pan.12552
Moll J, Erb TO, Frei FJ. Assessment of Three Placement Techniques for Individualized Positioning of the Tip of the Tracheal Tube in Children Under the Age of 4 Years. Paediatr Anaesth. 2015;25(4):379-85. PubMed PMID: 25308697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of three placement techniques for individualized positioning of the tip of the tracheal tube in children under the age of 4 years. AU - Moll,Jens, AU - Erb,Thomas O, AU - Frei,Franz J, Y1 - 2014/10/11/ PY - 2014/09/09/accepted PY - 2014/10/14/entrez PY - 2014/10/14/pubmed PY - 2015/12/15/medline KW - airway KW - cuff KW - endotracheal KW - pediatric KW - positioning KW - tube SP - 379 EP - 85 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 25 IS - 4 N2 - BACKGROUND: Accurate positioning of the tip of the tracheal tube (tube tip) is challenging in young children. Prevalent clinical methods include placement of intubation depth marks, palpation of the tube cuff in the suprasternal notch, or deliberate mainstem intubation with subsequent withdrawal. To compare the predictability of tube tip positions, variability of the resulting positions in relation to the carina was determined applying the three techniques in each patient. METHODS: In 68 healthy children aged ≤4 years, intubation was performed with an age-adapted, high-volume low-pressure cuffed tube adjusting the imprinted depth mark to the level of the vocal cords. The tube tip-to-carina distance was measured endoscopically. Thereafter, placements using (I) cuff palpation in the suprasternal notch and (II) auscultation to determine change in breath sounds during withdrawal after bronchial mainstem intubation were completed in random order. RESULTS: Tube tip position above the carina was higher when using depth marks (mean = 36.8 mm) compared with cuff palpation in the suprasternal notch (mean = 19.0 mm). Variability, expressed as sd, was lowest with the mainstem intubation technique (5.2 mm) followed by the cuff palpation (7.4 mm) and the depth mark technique (11.2 mm) (P < 0.005). CONCLUSION: Auscultation after deliberate mainstem intubation and cuff palpation resulted in a tube tip position above the carina that was shorter and more predictable than placement of the tube using depth markings. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/25308697/Assessment_of_three_placement_techniques_for_individualized_positioning_of_the_tip_of_the_tracheal_tube_in_children_under_the_age_of_4_years_ L2 - https://doi.org/10.1111/pan.12552 DB - PRIME DP - Unbound Medicine ER -