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Published on: September 28, 2022
Endotracheal tube cuff position in relation to the cricoid in children: A retrospective computed tomography-based
Tariq M Wani1, Jiju John1, Vladimir Bahun2
1Department of Anesthesiology, Sidra Medicine, Doha, Qatar.
Insights
Computed tomography (CT) imaging can identify endotracheal tube (ETT) cuff position in children. In 93% of cases, the ETT cuff was correctly placed below the cricoid ring, ensuring safe pediatric airway management.
Area of Science:
- Pediatric Imaging
- Airway Management
- Radiology
Background:
- Cuffed endotracheal tubes (ETT) are standard in pediatric care for airway seal.
- Proper ETT cuff placement distal to the cricoid ring is crucial for safe intubation.
- Computed tomography (CT) imaging's utility in verifying ETT cuff position requires evaluation.
Purpose of the Study:
- To assess the capability of CT imaging in identifying endotracheal tube (ETT) cuff position in pediatric patients.
- To determine the relationship between ETT cuff position and the cricoid ring using CT scans.
Main Methods:
- Retrospective analysis of neck and chest CT scans from 44 pediatric patients.
- Examination of sagittal plane CT images to record ETT cuff position.
- Utilizing vertebral levels as landmarks to estimate cricoid ring location relative to the ETT cuff.
Main Results:
- CT imaging successfully identified endotracheal tube (ETT) cuff position in children.
- The proximal edge of the ETT cuff was below the cricoid in 93% of patients (41/44).
- Deep ETT placement occurred in 6 patients, with 2 instances of mainstem bronchus intubation.
Conclusions:
- CT imaging is effective for visualizing endotracheal tube (ETT) cuff position in pediatric airways.
- The majority of pediatric patients demonstrated correct ETT cuff placement below the cricoid ring.
- Accurate ETT cuff positioning was observed regardless of patient age or ETT characteristics.
Background:
The use of cuffed endotracheal tubes (ETT) has become the standard of care in pediatric practice. The rationale for the use of a cuffed ETT is to minimize pressure around the cricoid while providing an effective airway seal. However, safe care requires that the cuff lie distal to the cricoid ring following endotracheal intubation. The current study demonstrates the capability of computed tomography (CT) imaging in identifying the position of the cuff of the ETT in intubated patients.
Methods:
In this retrospective study, the ETT cuff position was examined on the sagittal plane images of neck and chest CT scans of 44 children. The position of the proximal and the distal aspect of the ETT cuff inside the trachea was recorded in relation to the vertebral levels. The vertebral levels were used to estimate the location of the cricoid ring and its relationship to the cuff.
Results:
The vertebrae were used as the primary landmarks to define the position of the cricoid and its relationship to the cuff of the ETT. Correlating vertebral levels with the cricoid for different age groups, the proximal (cephalad) edge of the ETT cuff was below the cricoid in 41 of 44 patients (93%). The ETT cuff was deep in 6 patients, below the 1st thoracic vertebra, with 2 ETTs in the right mainstem bronchus.
Conclusion:
This is the first study demonstrating that the cuff of the ETT and its position in the trachea can be identified on CT imaging in children. The ETT cuff was below the level of the cricoid in the majority of patients irrespective of the patient's age as well as the size, make, and type of ETT.
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