Selection and placement of oral ventilation tubes based on tracheal morphometry

Area of Science:

• Anesthesiology
• Otolaryngology
• Medical Engineering

Background:

• Iatrogenic injuries to the trachea and larynx from endotracheal intubation are common due to a lack of evidence-based guidelines for ventilation tube selection and placement.
• Current practices rely on subjective criteria, leading to suboptimal outcomes.

Purpose of the Study:

• To establish evidence-based recommendations for selecting and placing ventilation tubes based on anatomical criteria.
• To develop a height-based nomogram for ventilation tube selection.

Main Methods:

• A prospective cross-sectional study involving 159 adult patients undergoing CT scans of the neck.
• Radiologic measurements included the distance from lower incisors to cricoid cartilage and the narrowest laryngotracheal diameter.
• Patient height was correlated with these anatomical measurements and compared with ventilation tube dimensions.

Main Results:

• The mean subcricoid tracheal diameter was 15.5 mm (coronal) and 17.1 mm (sagittal).
• Mean incisor-to-cricoid distance was 176.5 mm.
• Patient height significantly correlated with tracheal diameter and incisor-to-cricoid distance, but age and gender showed no significant correlation. Significant variations in dimensions were observed among tubes from different manufacturers.

Conclusions:

• Ventilation tube size and placement can be reliably determined using patient height.
• A height-based nomogram is essential for evidence-based selection and placement of ventilation tubes.
• A standardized, biometric-based labeling system for ventilation tubes is required to improve patient safety.