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Novel Formula for Calculation of the Optimal Insertion Depth for cuffed Endotracheal Tubes in Pediatric Major Surgery

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Open Journal of Anesthesiology 2019年第3期9卷 42-50页

作者： Mao Kinoshita Kazuma Hayase Mizuki Bando Naofumi Kawai Masaru Shimizu Masayuki Shibasaki Department of Anesthesiology Kyoto Prefectural University of Medicine Kamigyo Kyoto Japan

Background: Accurate determination of the optimal insertion depth of a pediatric endotracheal tube (ETT) is quite important. The aim of this study was to create an easily available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice. Methods: Eighty children under 12 years of age were enrolled. The depth marking of the cuffed ETT was placed at the vocal cords and both lungs were then auscultated using a stethoscope. The upper limit was radiographically defined as the position of the tip of the cuffed ETT being between the clavicles. The lower limit was defined as a distance of 5 mm above the carina. The relationship between the insertion depth and patient characteristics was analyzed to create a formula for optimal ETT insertion depth. Results: Sixty-nine ETTs were optimally placed in the trachea. There were good correlations between the optimal insertion depth of ETTs and patients characteristics (height (R = 0.92);BSA (R = 0.92);weight (R = 0.91);age (R = 0.88)). Using these patient characteristics, we created the following three formulas for calculation of the optimal insertion depth for pediatric cuffed ETTs: insertion depth (cm) = height (cm)/11 + 5.5, weight (kg)/3 + 9.5 or 11 + 3/4 × age (years). The rates of appropriate tube placement of both pediatric cuffed ETTs were 87.5% (Hi-Contour) and 85.0% (Microcuff). Conclusions: Our formula and graphs may be easy to determine the optimal insertion depth of cuffed ETT even without depth marking in clinical practice.

关键词： Insertion Depth Infants Small Children cuffed Endotracheal Tubes

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National Survey of Attitudes and Practices of Endotracheal Tube Management in Infants and Small Children in Japan

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Open Journal of Anesthesiology 2019年第2期9卷 9-22页

作者： Masayuki Shibasaki Yasuyuki Suzuki Tetsuro Kagawa Yasuhiro Kogure Keiichiro Mizuno Nobuaki Shime Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan Department of Critical Care and Anesthesia National Center for Child Health and Development Tokyo Japan Department of Anesthesia Hyogo Prefectural Kobe Children’s Hospital Kobe Japan Department of Anesthesia Fukuoka Children’s Hospital Fukuoka Japan Department of Emergency and Critical Care Medicine Hiroshima University Hiroshima Japan

Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 to 10 years of age. The aim of this study was to reveal the most recent attitudes and clinical practices of pediatric ETT management in Japan. Methods: The attitudes and clinical practices of pediatric ETT management were investigated using the data sheets of each institution and each patient. The data sheets contained information on patient characteristics and type of hospital, surgical procedures, devices used for intubation, and ETT information including types, size, depth, intracuff pressure (ICP), interval of ICP measurement, laryngeal packing, ETT exchange, airway complications, and reintubations. Results: The response rate of this survey was 66.7%. More than half of children older than 2 years of age were intubated with cuffed ETTs;83.5% of cuffed ETTs were used with the cuffs inflated, and ICP was measured in 80.7% of cuffed ETTs. More than half of ICP measurements were only taken at the time of intubation. Post-extubation stridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The pediatric ETT management questionnaire revealed age-based size selection, differences in pressure of air leakage between cuffed (15 - 20 cmH2O) and uncuffed ETTs (20 - 30 cmH2O) of different sizes, the depthmarking method of insertion length. Continuous measurement of ICP was not common. Conclusion: This study revealed widespread use of cuffed ETTs in children older than 2 years of age, rarely occurrence of post-extubation stridor, inflation of cuffs, and practice of ICP measurement.

关键词： cuffed Endotracheal Tube Size Selection Depth Determination Intracuff Pressure Infants Small Children

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A Comparison of the Best Place to Fix Endotracheal Tubes for Men and Women When Men and Women Are in the Same Height

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Open Journal of Anesthesiology 2014年第7期4卷 153-158页

作者： Shahram Nafisi Mehdi Rajabi Mohammad Afshar Morteza Rashidian Mitra Mohammadzadeh Department of Anesthesiology Advocate Illinois Masonic Medical CenterChicagoILUSA Department of Anesthesia and Critical Care Kashan University of Medical SciencesKashanIran Faculty of Nursing and Midwifery Kashan University of Medical SciencesKashanIran Clinical Innovation Ins Trials Costa MesaCAUSA Shahid Beheshti University of Medical Sciences TehranIran

Background: Comparison of the tracheal tube depth over the same body height of men and women based upon intubation depth markings. Methods: Kashan University of Medical Sciences ethics committee approved the study and written informed consent was taken for each patient. Patients undergoing surgery requiring general anesthesia with oro-tracheal intubation were included in a prospective observational study. After induction of general anesthesia, the endotracheal tube was secured at the point at which the cuff was just below the vocal cord on laryngoscopy. Results: In a statistical study of 682 intubated patients which consisted of 499 women and 183 men, 28 cases of laryngoscopic view grade III and IV were excluded from the study. The measurement markings on the ETT at the level of right corner of the mouth were 20.65 ± 0.13 and 18.52 ± 0.08 for men and women respectively (CI 95%). Patient’s height has a meaningful correlation with the measurement of the fixation point of the ETT. Pearson correlation coefficient between the securing point of the tube and height was 0.2 and 0.357 for men and women respectively. In most cases of men and women of the same height, Mann-Whitney U test rejected the hypothesis that the tube can be fixed in the particular point. Conclusions: In general, men are taller than women. Comparing the fixation depth of the tube, even when man and woman have the same body height, the endotracheal tube might be placed in a deeper level for men rather than women.

关键词： Intubation Endotracheal Tube General Anesthesia Height cuffed

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