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Tube tip and cuff position using different strategies for placement of currently available paediatric tracheal tubes

M Kemper1, S Imach1, P K Buehler1

  • 1Department of Anaesthesia and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.

British Journal of Anaesthesia
|July 24, 2018
PubMed

Insights

Paediatric cuffed tracheal tubes have design flaws leading to incorrect placement and potential airway complications. Manufacturers must improve designs, as current tubes risk bronchial intubation or cuff malpositioning.

Area of Science:

  • Pediatric Anesthesiology
  • Airway Management
  • Medical Device Design

Background:

  • Tracheal tube tip and cuff positioning varies significantly among different cuffed pediatric tracheal tube brands.
  • These variations are attributed to inherent design differences in the tubes.

Purpose of the Study:

  • To evaluate the positioning accuracy of various cuffed pediatric tracheal tube brands.
  • To identify potential risks of airway complications associated with different placement strategies.

Main Methods:

  • Pooled data from three clinical studies involving 422 children (birth to 16 years).
  • Analyzed dimensional data of seven cuffed pediatric tracheal tube brands (ID 3.0-7.0 mm).
  • Calculated tube tip and cuff positions using depth mark, safety distance, and mid-tracheal placement strategies.

Main Results:

  • Depth mark placement led to up to 18% bronchial intubation and 91% subglottic cuff placement.
  • Safety distance placement resulted in up to 54% of cuffs positioned too high.
  • Mid-tracheal placement caused 100% of cuffs to be subglottic or supraglottic.

Conclusions:

  • All studied cuffed pediatric tracheal tubes exhibit design flaws that can cause airway complications.
  • Urgent improvements in the design of cuffed pediatric tracheal tubes are recommended.
  • Alternative placement strategies may enable safe use of uncuffed tubes but not cuffed ones.
Abstract

Keywords:
airway managementcomplicationspaediatrictracheal intubationtracheal tube

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