Larger Endotracheal Tubes Are Associated With an Increased Risk of Post-Extubation Diet Modifications

There are no widely adopted guidelines regarding appropriate endotracheal tube (ETT) sizing. While it is proposed that larger ETTs may be associated with an increased risk for upper aerodigestive injury, a robust relationship has not yet been established. In this study, we assessed the association between ETT size and post-extubation diet recommendations.

Patients undergoing endotracheal intubation at our institution were retrospectively identified through ICD-10 PCS codes. The relationship between ETT size and diet recommendations given by speech and language pathology was explored through univariable and multivariable regression analyses.

We identified 1181 patients. The mean ± SD age was 66 ± 14 years, the median [IQR] approximated Charlson Comorbidity Index (CCI) was 5 [3, 7], and the median [IQR] length of stay was 19 [9, 33]. Overall, individuals recommended any diet modifications were older (68 ± 13 vs. 64 ± 14, p < 0.001) and more frequently underwent an emergency intubation (21% vs. 16%, p = 0.01). We utilized a height-based nomogram to classify endotracheal tubes as smaller than expected, as expected, or larger than expected. On multivariable analysis adjusting for length of stay, CCI, emergency intubations, smoking status, circulatory shock, history of GERD, weight, and height, each 1.0 unit increase in ETT size was associated with twice the odds of a recommendation for any diet modification (OR: 2.05, 95% CI: 1.49-2.85).

Increased ETT sizes may be associated with a greater risk of upper aerodigestive injury. Future studies to validate these findings and develop guidelines regarding the appropriate sizing of ETTs are needed.