Assessment of three placement techniques for individualized positioning of the tip of the tracheal tube in children under the age of 4 years

作者：Moll Jens^*; Erb Thomas O; Frei Franz J

来源：Paediatric Anaesthesia, 2015, 25(4): 379-385.

DOI：10.1111/pan.12552

• pediatric
• airway
• endotracheal
• tube
• cuff
• positioning

BackgroundAccurate 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.
MethodsIn 68 healthy children aged 4years, 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.
ResultsTube tip position above the carina was higher when using depth marks (mean=36.8mm) compared with cuff palpation in the suprasternal notch (mean=19.0mm). Variability, expressed as sd, was lowest with the mainstem intubation technique (5.2mm) followed by the cuff palpation (7.4mm) and the depth mark technique (11.2mm) (P<0.005).
ConclusionAuscultation 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.

• 出版日期2015-4