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.

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.

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.

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 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.

scholarly journals Ultrasound compared to Age Related Formulas for prediction of Pediatric Endotracheal Tube Size

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A Abdelghany ◽  
N Nasr ◽  
S Talaat ◽  
M Mansour ◽  
T Shabana
Keyword(s):  
Endotracheal Tube ◽  
Airway Pressure ◽  
Ultrasound Measurement ◽  
Outer Diameter ◽  
Transverse Diameter ◽  
Tube Size ◽  
Group Iii ◽  
Age Related ◽  
Group I ◽  
Group Ii

Abstract Background In pediatric patients, having proper size of endotracheal tube (ETT) is crucial. The practice of using age-based formulas to calculate the ETT size is easy, practical and commonly used today. However, the incidence of inappropriate tube size is still judicious, hence increasing risk from changing tube such as trauma and aspiration. Recent studies found that measuring the narrowest transverse subglottic diameter may guide the proper tube size Aim This study was aimed to proof that selecting ETT size using ultrasound measurement of subglottic diameter is a reliable method and lead to less frequency of changing tube size than age-based formula especially in older children Materials and Methods 60 children aged between 2 to 12 years, of both genders, American society of anesthesiologists (ASA) I or II physical status scheduled for day case surgery under general endotracheal anesthesia. Children were divided randomly according to age into three groups: group I included children aged between 2 to &lt; 5 years, group II included children aged between 5 to &lt; 9 years, and group III included children aged between 9 to 12 years. In all childern, the size of the ETT was determined according to both ultrasonography and modified cole's formula. The size of the ETT initially inserted was based on ultrasonographic calculation. Ultrasonography is done using high–resolution linear ultrasound probe. The probe was positioned at the anterior aspect of neck in the midline with the head extended and neck flexed (sniffing position). The minimal transverse diameter of the subglottic airway (MTDSA) was estimated at the level of cricoid cartilage at zero cmH2O airway pressure. After measurement of the subglottic diameter, uncuffed ETT with the nearest outer diameter (OD) corresponding to the measured subglottic diameter was selected for intubation. If there was resistance to ETT passage into the trachea, or there was no audible leak when the lungs were inflated to a pressure of 20–30 cm H2O, the tube was exchanged with one that is 0.5 mm smaller. In contrast, the ETT was exchanged for one that is 0.5 mm larger if leaks occurred at an inflation pressure less than 10 cm H2O. Optimal tube size was clinically determined by leakage at airway pressure of 10-20 cmH2O. Results Linear correlation study showed that Ultrasonography was a better predictor for optimal ETT size in pediatrics than Cole's formula for all studied groups especially in older age groups (although both were significant); being 0.669 Vs. 0.613 among group I; 0.955 Vs. 0.808 among group II and 0.863 Vs. 0.707 among group III. Multi-regression analysis showed that both Ultrasonography & Cole's formula were highly sensitive independent predictors that can predict Optimal ETT size in pediatrics (F-Ratio = 524.7, p &lt; 0.001); The prediction formula is: Optimal ETT size ID = -0.091 + 0.814(ID obtained by US) + 0.192(ID obtained by Cole's formula). Conclusion Ultrasound is a safe, reliable, non-invasive tool for selection of appropriately sized endotracheal tube for clinical use. Our study validates the reliability of ultrasound to measure subglottic diameter which avoids intubation related complications of either trauma or inefficient ventilation.

Sign in / Sign up

Export Citation Format

Share Document