Journal of clinical anesthesia · 2016
Endotracheal tube displacement during head and neck movements. Observational clinical trial.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Tailleur Robert, Bathory Istvan, Dolci Mirko, Frascarolo Philippe, Kern Christian, Schoettker Patrick
Аннотация
STUDY OBJECTIVE: Measure the displacements of endotracheal tube (ETT) tip displacement during head and neck movements.
DESIGN: Observational study.
SETTING: Ear-nose-throat (ENT) and neurosurgery operating room.
PATIENTS: We performed a maximal head-neck movement trial on 50 adult patients, American Society of Anaesthesiologists 1 or 2. Patients with body mass index >35 kg · m(-2), height <150 cm, airway malformations, pulmonary diseases, difficulties in neck flexion or extension, previous ENT surgery or radiotherapy, gastroesophageal reflux, or dental instability were excluded from the study.
INTERVENTIONS: ENT and neurosurgery.
MEASUREMENTS: We measured the change in distance between the ETT tip and the carina, using a fiberscope through the ETT.
RESULTS: After intubation, a wide disparity of tube tip distance to the carina in the neutral position was noted with a median of 5.0 (3.5-7.0) cm. Cephalad tube movement was documented following maximal head and neck extension in 34 (68%) patients and right head rotation in 25 patients (50%). Caudal tube displacement was due to maximal head and neck flexion in 38 patients (76%) and left head rotation in 25 patients (50%). Selective right main bronchus intubation was noted in 2 (4%) patients after maximal head extension.
CONCLUSION: Maximal head and neck movements led to unpredictable tube displacements. Proper reassessment of tube positioning after head and neck movement of intubated patients is therefore mandatory.
DESIGN: Observational study.
SETTING: Ear-nose-throat (ENT) and neurosurgery operating room.
PATIENTS: We performed a maximal head-neck movement trial on 50 adult patients, American Society of Anaesthesiologists 1 or 2. Patients with body mass index >35 kg · m(-2), height <150 cm, airway malformations, pulmonary diseases, difficulties in neck flexion or extension, previous ENT surgery or radiotherapy, gastroesophageal reflux, or dental instability were excluded from the study.
INTERVENTIONS: ENT and neurosurgery.
MEASUREMENTS: We measured the change in distance between the ETT tip and the carina, using a fiberscope through the ETT.
RESULTS: After intubation, a wide disparity of tube tip distance to the carina in the neutral position was noted with a median of 5.0 (3.5-7.0) cm. Cephalad tube movement was documented following maximal head and neck extension in 34 (68%) patients and right head rotation in 25 patients (50%). Caudal tube displacement was due to maximal head and neck flexion in 38 patients (76%) and left head rotation in 25 patients (50%). Selective right main bronchus intubation was noted in 2 (4%) patients after maximal head extension.
CONCLUSION: Maximal head and neck movements led to unpredictable tube displacements. Proper reassessment of tube positioning after head and neck movement of intubated patients is therefore mandatory.