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Is endotracheal tube displacement during head and neck extension due to ascending movement or tracheal lengthening? An observational ultrasonographic study

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Abstract

Complications of the endotracheal tube (ETT) displacement during head and neck positional changes are related to not only the tip position but also the cuff pressure against the larynx. Here, we evaluated movement of the ETT cuff relative to laryngeal structures as well as tip displacement from the carina.

Sixty-two patients scheduled for thyroidectomy were recruited. The distance from the cricoid cartilage to the upper margin of the cuff (CC) and that from the ETT tip to the carina (TC) were measured using ultrasonography and fiberoptic bronchoscopy, respectively, during flexion and extension. The total tracheal length (TTL) was defined as the combination of CC, TC, and the distance from the upper margin of the cuff to the tip.

During flexion, the CC and TC were 1.5 ± 0.6 and 2.9 ± 1.0 cm respectively. Seven patients (11.7%) exhibited excessively deep intubation. After adjusting the cuff position under ultrasonography (CC = 0), the tip position was corrected in 96.7%. While the TC increased by 2.1 ± 1.0 cm after the positional change in extension, the CC decreased by 0.6 ± 0.7 cm because the TTL lengthened (1.4 ± 1.1 cm). Four patients (6.7%) exhibited excessive cuff displacement beyond the cricoid cartilage, which could have been corrected under ultrasonography.

In conclusion, the ETT cuff displaced toward the larynx in a less degree than the tip did from the carina due to the tracheal lengthening during head and neck extension. Nevertheless, we suggest that ultrasonographic assessment of cuff position may avoid ETT misplacement.

Trial registration https://cris.nih.go.kr/ (approval no. KCT0005319); registered on May 14, 2019.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Chonnam National University Hwasun Hospital, Hwasun, Chonnam, Republic of Korea

    Dong Ho Kang MD, Hyun Eung You MD & Woong Mo Kim M.D., Ph.D.

  2. Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea

    Seung Hoon Kim MD & Woong Mo Kim M.D., Ph.D.

  3. Department of Anesthesiology and Pain Medicine, Medical School, Chonnam National University, 42 Jebongro, 501-757, Donggu, Gwangju, Republic of Korea

    Woong Mo Kim M.D., Ph.D.

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  1. Dong Ho Kang MD
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  2. Seung Hoon Kim MD
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Contributions

Conceptualization: Woong Mo Kim; Methodology: Woong Mo Kim, Dong Ho Kang; Formal analysis and investigation: Woong Mo Kim, Seung Hoon Kim; Writing—original draft preparation: Seung Hoon Kim, Dong Ho Kang; Writing—review and editing: Woong Mo Kim, Seung Hoon Kim, Dong Ho Kang ; Resources: Dong Ho Kang, Hyun Eung You; Supervision : Woong Mo Kim.

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Correspondence to Woong Mo Kim M.D., Ph.D..

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the Institutional Review Board of Chonnam National University Hwasun Hospital Board (approval no. CNUHH-2019-095) before participant enrollment began.

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Informed consent was obtained from all individual participants included in the study.

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Author Dong Ho Kang and Author Seung Hoon Kim are co-first authors and contributed equally to this work.

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Kang, D.H., Kim, S.H., You, H.E. et al. Is endotracheal tube displacement during head and neck extension due to ascending movement or tracheal lengthening? An observational ultrasonographic study. J Clin Monit Comput 37, 139–145 (2023). https://doi.org/10.1007/s10877-022-00870-w

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