Intubation depth markings allow an improved positioning of endotracheal tubes in children

Le marquage de la profondeur ďinsertion permet ďaméliorer la mise en place de tubes endotrachéaux chez les enfants

Abstract

Objectives

To evaluate the position of the new Microcuff® pediatric tracheal tube, based upon intubation depth markings.

Methods

With Institutional Ethics Committee approval and informed parental consent, we included patients from birth (≥ 3 kg) to 16 yr undergoing interventional cardiac catheterization requiring general anesthesia with oro-tracheal intubation. The intubation depth mark of the tracheal tube was placed between the vocal cords by direct laryngoscopy. The distance between tube tip and tracheal carina was measured from routinely taken cardiac catheterization posterior-anteriorx-ray computer images with the patient supine and the head in a neutral position. Evaluation was performed for 20 tubes size 3.0 mm internal diameter (ID) and for ten tubes of each size from 3.5 to 7.0 mm ID.

Results

100 patients were studied (47 girls; 53 boys). Tracheal tube tip advancement into the trachea ranged from 40.6% to 68.6% (median 51.4%). The shortest distance from tube tip to the tracheal carina was 15.7 mm using a 3.0 mm ID tube. Using a standard formula for tube insertion in children aged ≥ two years [12 cm + (age/2)], in one patient the tube tip would have been below the carina and in seven patients the tube cuffs would have been placed within the larynx.

Conclusion

The intubation depth markings of the new Microcuff® pediatric tracheal tube allow safe placement of the tracheal tube with a cuff-free laryngeal zone without the risk for endobronchial intubation. Placement using the intubation depth markings was superior to predicted insertion using a standard formula.

Résumé

Objectif

Évaluer la position du nouveau tube endotrachéal pédiatrique Microcuff® ďaprès le marquage de la profondeur du tube.

Méthode

Avec ľaccord du Comité ďéthique et des parents, nous avons étudié des patients, de bébé naissant (≥3 kg) à 16 ans, devant subir une exploration cardiaque par cathétérisme nécessitant une anesthésie générale avec intubation orotrachéale. La marque de la profondeur ďinsertion du tube a été placée entre les cordes vocales par laryngoscopie directe. Le patient étant couché et sa tête en position neutre, la distance entre la pointe du tube et la carène de la trachée a été mesurée à partir ďimages radiographiques informatisées postéro-antérieures, couramment prises, du cathétérisme cardiaque. L’évaluation a été réalisée pour 20 tubes de diamètre interne (DI) de 3,0 mm et pour 10 tubes de chaque taille entre 3,5 et 7,0 mm de DI.

Résultats

Nous avons étudié 100 patients (47 filles et 53 garçons). Le pourcentage ďoccupation de la trachée par le tube endotrachéal variait de 40,6 % à 68,6 % (médiane de 51,4 %). La plus courte distance entre la pointe du tube et la carène a été de 15,7 mm avec un tube de DI de 3,0 mm. Selon la formule standard ďinsertion ďun tube chez les enfants de ≥deux ans [12 cm + (âge/2)], la pointe du tube aurait été en un point distal de la carène chez un patient et le ballonnet au niveau du larynx chez sept patients.

Conclusion

Le marquage de la profondeur ďinsertion du nouveau tube endotrachéal pédiatrique Microcuff® permet une mise en place sûre du tube et assure une zone laryngée libre de ballonnet sans le risque ďintubation endobronchique. Le placement guidé par des marques de profondeur du tube a été supérieur à ľinsertion prédite selon la formule standard.

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Correspondence to Markus Weiss or Christian Balmer or Alexander Dullenkopf or Walter Knirsch or Andreas Ch. Gerber or Urs Bauersfeld or Felix Berger.

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Weiss, M., Balmer, C., Dullenkopf, A. et al. Intubation depth markings allow an improved positioning of endotracheal tubes in children. Can J Anesth 52, 721 (2005). https://doi.org/10.1007/BF03016560

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Keywords

  • Vocal Cord
  • Tracheal Tube
  • Tube Cuff
  • Cheal Tube
  • Institutional Ethic Committee Approval