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Tracheal tube-tip displacement in children during head-neck movement--a radiological assessment

M Weiss1, W Knirsch, O Kretschmar

  • 1Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland. markus.weiss@kispi.unizh.ch

British Journal of Anaesthesia
|February 9, 2006
PubMed

Insights

Pediatric tracheal tube depth marks are appropriate, but the cuff may shift into the subglottic region during neck extension, requiring adjustment.

Area of Science:

  • Pediatric Anesthesiology
  • Airway Management
  • Medical Device Evaluation

Background:

  • Assessing tracheal tube tip displacement during head-neck movement in children is crucial.
  • Evaluating the accuracy of depth markings on pediatric endotracheal tubes is essential for patient safety.

Purpose of the Study:

  • To determine the maximum displacement of the tracheal tube tip in children during head-neck movements.
  • To assess the suitability of Microcuff Paediatric Endotracheal Tube depth markings to prevent extubation or endobronchial intubation.

Main Methods:

  • Fluoroscopic assessment of tracheal tube tip-to-carina distance in 100 children (birth to adolescence).
  • Measurements taken with the head-neck in neutral, 30° flexion, and 30° extension positions.
  • Tracheal tubes were orally intubated with the depth mark at the vocal cord level.

Main Results:

  • Maximum tracheal tube tip displacement showed a linear relationship with age.
  • Downward displacement during flexion was greater than upward displacement during extension.
  • Formulas derived for predicting maximal upward and downward tube movement based on age.

Conclusions:

  • The intubation depth marks on the Microcuff Paediatric Endotracheal Tube are appropriate for preventing inadvertent extubation and endobronchial intubation.
  • The tracheal tube cuff may move into the subglottic region during neck extension and may require readjustment.
  • Continuous monitoring and potential re-adjustment of the tracheal tube position are recommended, especially during prolonged head-neck extension.
Abstract

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