scholarly journals X-Ray and CT Scan Based Prediction of Best Fit Tracheostomy Tube—A Pilot Study

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 506
Author(s):  
Mel Corbett ◽  
Isobel Hughes ◽  
John O’Shea ◽  
Matthew G. Davey ◽  
Jane Savage ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Tracheostomy Tube ◽  
Ventilatory Support ◽  
Preoperative Imaging ◽  
Internal Diameter ◽  
Tube Size ◽  
Computed Tomography Scans ◽  
Risk Patients ◽  
Tracheostomy Tubes ◽  
Best Fit

Tracheostomy is a commonly performed intervention in patients requiring ventilatory support. The insertion of inappropriately sized tracheostomy tubes carries a risk of decannulation, tissue damage, ventilatory difficulties, premature tube change or discomfort. Currently, no clear guidelines exist in determining the most appropriate size tube. Imaging of the airway preoperatively could aid clinical judgement and reduce risk. Patients included adult critical care patients who had appropriate preoperative imaging. The computed tomography scans and chest radiographs of patients were reviewed. Measurements of the airway were taken and scaled to the known internal diameter of an endotracheal tube. A four-point scoring system was developed to identify patients better suited to a non-standard sized tracheostomy tube. Data from 23 patients was analyzed using the Statistical Package for Social Sciences™ (SPSS). Four measured points on imaging corresponded to the patients’ appropriate tracheostomy tube size. Appropriate tracheostomy size correlates with tracheal diameter at endotracheal tube tip (r2 = 0.135), carina (r2 = 0.128), midpoint of larynx to carina (r2 = 0.146), bronchial diameter at the left mainstem (r2 = 0.323), and intrathoracic tracheal length (r2 = 0.23). Among our cohort, a score of 4 predicts the need for a larger tracheostomy tube. Simple imaging provides accurate measurement of patients’ airway dimensions. Our method ensures tube size is selected according to patient airway size, and potentially reduces the risks associated with inappropriate sizing.

Evaluation of Two Methods of Endotracheal Tube Selection in Dogs

2008 ◽  
Vol 44 (5) ◽  
pp. 236-242 ◽  
Author(s):  
Jim Lish ◽  
Jeff C. H. Ko ◽  
Mark E. Payton
Keyword(s):  
Endotracheal Tube ◽  
Internal Diameter ◽  
Outer Diameter ◽  
Selection Methods ◽  
Tube Size ◽  
Digital Palpation ◽  
Best Fitting ◽  
Selection For ◽  
Best Fit ◽  
Endotracheal Tube Size

This study evaluated two methods of endotracheal tube selection using 28 fresh canine carcasses of various ages, weights, and genders. The two selection methods were 1) nasal septal width pairing with outer diameter of an endotracheal tube, and 2) digital palpation of the tracheal outer diameter to determine the endotracheal tube size. All dogs were dolichocephalic breeds. Results of this study showed that the canine nasal septal width method of endotracheal tube selection was correlated with the size of the tracheal internal (r=0.72) and outer (r=0.73) diameters. However, evidence shows that the digital palpation method is slightly more effective than the nasal width method in selecting the best-fitting endotracheal tube. The percentage of the best-fit tube selection for the nasal septal width method was 21%, while the digital palpation method was 46%. With these two methods, selecting an endotracheal tube that is too small is possible, especially when the tube internal diameter is ≥7 mm.

Incidence and determinants of malpositioning tracheostomy tubes in critically ill adult patients

2021 ◽  
pp. 0310057X2110392
Author(s):  
Prakkash P Ananthan ◽  
Kwok M Ho ◽  
Matthew H Anstey ◽  
Bradley A Wibrow
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Tracheostomy Tube ◽  
Clinical Audit ◽  
Internal Diameter ◽  
Air Leak ◽  
Common Cause ◽  
Factors Associated ◽  
Tracheal Stoma ◽  
Tracheostomy Tubes

Tracheostomy tubes are chosen primarily based on their internal diameter; however, the length of the tube may also be important. We performed a prospective clinical audit of 30 critically ill patients following tracheostomy to identify the type of tracheostomy tube inserted, the incidence of malpositioning and the factors associated with the need to change the tracheostomy tube subsequently. Anthropometric neck measurements, distance between the skin and tracheal rings and the position of the tracheostomy cuff relative to the tracheal stoma were recorded and analysed. Malpositioning of the tracheostomy tube was noted in 20%, with a high riding cuff being the most common cause of malpositioning, resulting in an audible leak and a need to change the tracheostomy tube subsequently. A high riding cuff was more common when a small tracheostomy tube (e.g. Portex (Smiths Medical Australasia, Macquarie Park, NSW) ≤8.0 mm internal diameter with length <7.5 cm) was used, with risk further increased when the patient’s skin to trachea depth was greater than 0.8 cm. Identifying a high riding cuff relative to the tracheal stoma confirmed by a translaryngeal bronchoscopy strongly predicted the risk of air leak and the need to change the tracheostomy tube subsequently. Our study suggests that when a small (and short) tracheostomy tube is planned for use, intraoperative translaryngeal bronchoscopy is warranted to exclude malpositioning of the tracheostomy tube with a high riding cuff.

Tracheostomy or Endotracheal Intubation

1974 ◽  
Vol 83 (6) ◽  
pp. 739-743 ◽  
Author(s):  
Randolph M. Ferlic
Keyword(s):  
Endotracheal Tube ◽  
Critically Ill ◽  
Endotracheal Intubation ◽  
Tracheostomy Tube ◽  
Ventilatory Support ◽  
Respiratory Support ◽  
Current Management ◽  
Support Size ◽  
Injured Patients

Current management of many critically ill and injured patients demands ventilatory support. The option of support through an endotracheal or tracheostomy tube is governed by eight factors: Shape of the tube, area of the cuff, material, illness or injury prompting respiratory support, size of the patient and airway, humidity, activity of the larynx and time involved in support. Review of our own experience and that of others prompts the conclusion that endotracheal intubation is relatively safe, should be used almost exclusively in infants, and is tolerated well by adults for periods to six days. Secondary tracheostomy will be required for adults requiring longer periods of support and those patients in whom secretions are too thick or copious to be managed by suctioning through the endotracheal tube. Obviously, there are some patients whose illness or injury will leave no option as to the route of intubation.

Endotracheal and Tracheostomy Tube Cytology

1979 ◽  
Vol 88 (6) ◽  
pp. 809-812 ◽  
Author(s):  
J. Kevin Fortson ◽  
Parviz Janfaza
Keyword(s):  
Lung Carcinoma ◽  
Tracheostomy Tube ◽  
Effective Means ◽  
Survival Rates ◽  
Cost Effective ◽  
Tracheobronchial Tree ◽  
Screening Methods ◽  
Upper Aerodigestive Tract ◽  
Risk Patients ◽  
Tracheostomy Tubes

Carcinoma of the lung is the leading cause of death from malignancy in this country. Twenty percent of patients with lung carcinoma are asymptomatic early in the course of the disease. Survival rates are much better when lung carcinoma is discovered at the asymptomatic or radiographically occult stage, therefore improved screening methods should be investigated. Many tumors in the tracheobronchial tree shed malignant cells into the bronchi and sputum cytology has been of value in the early diagnosis of carcinoma of the tracheobronchial tree. Thousands of patients are intubated daily. During endotracheal anesthesia, secretions are stimulated in the tracheobronchial tree and endotracheal or tracheostomy tubes are coated with these secretions. In a preliminary study, the cytology examination of the secretions adherent to 50 endotracheal tubes suggests that endotracheal and tracheostomy tube cytology will prove to be a reliable, noninvasive and cost-effective means of screening high risk patients for occult primary carcinomas of the lung and upper aerodigestive tract.

scholarly journals Estimation of Appropriate Endotracheal Tube Size in Pediatric Patients: Use of Epiphyseal Diameter of the Distal Radius and Subglottic Diameter

2021 ◽  
Author(s):  
Demet Altun ◽  
Can Doruk ◽  
Müşerref Beril Dinçer ◽  
Meltem Merve Güler
Keyword(s):  
Endotracheal Tube ◽  
Distal Radius ◽  
Pediatric Patients ◽  
Outer Diameter ◽  
Transverse Diameter ◽  
Tube Size ◽  
The Us ◽  
Tube Exchange ◽  
Best Fit ◽  
Endotracheal Tube Size

INTRODUCTION: The aim of this study is to test the usefulness of epiphysis of distal radius measurement as a surrogate parameter for endotracheal tube (ETT) size prediction in children. METHODS: Seventy-three children were intubated with cuffed ETT selected according to age-based formula. Transvers diameter of epiphysis of distal radius and subglottic diameter of trachea were measured by ultrasound (US). Correlation between the outer diameter of best-fit endotracheal tube and transvers diameter of both radius epiphysis and subglottic diameter were calculated. The need for tube exchange, time for ultrasound (US) measurements and the ease level of measurements were compared. RESULTS: First attempt success at intubation was 83.6%. The correlation of the epiphysis diameter of the distal radius and best-fit ETT was significant (p<0.001, r= 0.619, r2=0.383, 95% CI=0.419-0.838). Similarly the correlation of subglottic tracheal diameter and best-fit ETT was significant (p<0.001, r=0.744, r2=0.553, 95% CI=0.678-825). Estimated ETT sizes according to radial epiphysis diameter and subglottic diameter were optimal in 82.2% and 94.5% respectively. Time for the US measurements of radial epiphysis and subglottic area were 38.3±9.6 and 24.9±4.6 seconds respectively (p<0.001). The level of ease of US measurements were rated for radial epiphysis as 6 (5-9) and for subglottic area as 8 (7-9) (p<0.001). DISCUSSION AND CONCLUSION: US measured transverse diameter of distal radius epiphysis resulted in similar success rate to age-based formula in our child population. Subglottic diameter measured by US estimates ETT size more accurately; it is also less time consuming and easier.

Impact of endotracheal tube size and cuff pressure on tracheal and laryngeal mucosa of adult horses

2021 ◽  
Author(s):  
Tatiana H. Ferreira ◽  
Molly Allen ◽  
Diego De Gasperi ◽  
Kevin A. Buhr ◽  
Samantha L. Morello
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Tube Size ◽  
Laryngeal Mucosa ◽  
Endotracheal Tube Size

scholarly journals A Case of Secondary Aortoesophageal Fistula Inserted a Covered Self-Expanding Esophageal Stent to Control Gastrointestinal Bleeding

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Makoto Onodera ◽  
Yoshihiro Inoue ◽  
Yasuhisa Fujino ◽  
Satoshi Kikuchi ◽  
Shigeatsu Endo
Keyword(s):  
High Risk ◽  
Surgical Intervention ◽  
Esophageal Stent ◽  
Aortoesophageal Fistula ◽  
Endovascular Stent Graft ◽  
Computed Tomography Scans ◽  
Feasible Option ◽  
Risk Patients ◽  
Stent Graft Repair ◽  
Endovascular Stent Graft Repair

A 73-year-old man presented with melena. After a thorough workup including esophageal endoscopy, computed tomography scans, and esophagography, the diagnosis of secondary aortoesophageal fistula was made. Two years previously, he had undergone endovascular stent-graft repair for the dissection of his descending thoracic aorta. Because of the generally poor condition of the patient and the high risk of any aggressive surgical intervention, we inserted a covered self-expanding esophageal stent on postadmission day 18. Esophagography after insertion did not show any evidence of a leak of contrast medium. Despite treatment with antibiotics, he developed sepsis and expired on day 52, but rebleeding did not occur in this period. We consider insertion of a covered self-expanding esophageal stent as a feasible option in the management of secondary aortoesophageal fistula in high-risk patients.

Management of the Extubation Problem in the Premature Child

1980 ◽  
Vol 89 (6) ◽  
pp. 508-511 ◽  
Author(s):  
Robin T. Cotton ◽  
Allan B. Seid
Keyword(s):  
Endotracheal Tube ◽  
Ventilatory Support ◽  
Disease Process ◽  
Upper Respiratory Tract ◽  
Endoscopic Evaluation ◽  
Newborn Period ◽  
Edema Formation ◽  
Premature Child ◽  
Upper Respiratory

Long-term endotracheal intubation is a widely established means of giving ventilatory support in the newborn period. Though such long-term intubation is well tolerated by the premature infant, laryngeal complications do occur and extubation may be impossible even though the initial disease process for which the intubation was performed has resolved. In such a situation, careful endoscopic evaluation of the upper respiratory tract is advocated to identify the site of the problem. If subglottic edema or mucosal ulceration in the subglottic area is the site of the damage and if, during endoscopic evaluation immediately following removal of the endotracheal tube, the subglottic area starts to narrow because of edema formation or edema fluid filling up compressed granulation tissue, then a split of the cricoid in the midline anteriorly, leaving the endotracheal tube in as a stent, appears to be a preferable alternative to performing a tracheotomy. Of 12 consecutive patients, 9 have been successfully extubated.

scholarly journals Efficacy of Pressure Support in Compensating for Apparatus Work

1993 ◽  
Vol 21 (1) ◽  
pp. 67-71 ◽  
Author(s):  
A. D. Bersten ◽  
A. J. Rutten ◽  
A. E. Vedig
Keyword(s):  
Endotracheal Tube ◽  
Flow Rate ◽  
Pressure Support ◽  
Work Of Breathing ◽  
Inspiratory Flow ◽  
Inspiratory Flow Rate ◽  
Respiratory Muscle Fatigue ◽  
Tube Size ◽  
Endotracheal Tubes ◽  
Endotracheal Tube Size

Breathing through an endotracheal tube, connector, and ventilator demand valve imposes an added load on the respiratory muscles. As respiratory muscle fatigue is thought to be a frequent cause of ventilator dependence, we sought to examine the efficacy of five different ventilators in reducing this imposed work through the application of pressure support ventilation. Using a model of spontaneous breathing, we examined the apparatus work imposed by the Servo 900-C, Puritan Bennett 7200a, Engstrom Erica, Drager EV-A or Hamilton Veolar ventilators, a size 7.0 and 8.0 mm endotracheal tube, and inspiratory flow rates of 40 and 60 l/min. Pressure support of 0, 5, 10, 15, 20 and 30 cm H2O was tested at each experimental condition. Apparatus work was greater with increased inspiratory flow rate and decreased endotracheal tube size, and was lowest for the Servo 900-C and Puritan Bennett 7200a ventilators. Apparatus work fell in a curvilinear fashion when pressure support was applied, with no major difference noted between the five ventilators tested. At an inspiratory flow rate of 40 l/min, a pressure support of 5 and 8 cm H2O compensated for apparatus work through size 8.0 and 7.0 endotracheal tubes and the Servo 900-C and Puritan Bennett 7200a ventilators. However, the maximum negative pressure was greater for the Servo 900-C. The added work of breathing through endotracheal tubes and ventilator demand valves may be compensated for by the application of pressure support. The level of pressure support required depends on inspiratory flow rate, endotracheal tube size, and type of ventilator.

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