Endotracheal tube displacement during head and neck movements. Observational clinical trial

Abstract Study Objective Measure the displacements of endotracheal tube (ETT) tip displacement during head and neck movements. Design Observational study. Setting Ear-nose-throat (ENT) and neurosurgery operating room. Patients We performed a maximal head-neck movement trial on 50 adult patients, Ame...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2016-08, Vol.32, p.54-58
Main Authors: Tailleur, Robert, MD, Bathory, Istvan, MD, Dolci, Mirko, MD, Frascarolo, Philippe, PhD, Kern, Christian, MD, Dept.-Head, Schoettker, Patrick, MD, PD
Format: Article
Language:English
Subjects:
Adult
Adults
Anesthesia
Anesthesia & Perioperative Care
Body mass index
Clinical trials
Displacement
Endotracheal
Female
Fiberscopy
Head Movements
Humans
Intubation
Intubation, Intratracheal - instrumentation
Larynx
Male
Middle Aged
Movement
Neck
Observational studies
Pain Medicine
Patient Positioning - adverse effects
Patients
Pediatrics
Posture
Surgery
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Summary:Abstract Study Objective Measure the displacements of endotracheal tube (ETT) tip displacement during head and neck movements. Design Observational study. Setting Ear-nose-throat (ENT) and neurosurgery operating room. Patients We performed a maximal head-neck movement trial on 50 adult patients, American Society of Anaesthesiologists 1 or 2. Patients with body mass index > 35 kg · m − 2 , height < 150 cm, airway malformations, pulmonary diseases, difficulties in neck flexion or extension, previous ENT surgery or radiotherapy, gastroesophageal reflux, or dental instability were excluded from the study. Interventions ENT and neurosurgery. Measurements We measured the change in distance between the ETT tip and the carina, using a fiberscope through the ETT. Results After intubation, a wide disparity of tube tip distance to the carina in the neutral position was noted with a median of 5.0 (3.5-7.0) cm. Cephalad tube movement was documented following maximal head and neck extension in 34 (68%) patients and right head rotation in 25 patients (50%). Caudal tube displacement was due to maximal head and neck flexion in 38 patients (76%) and left head rotation in 25 patients (50%). Selective right main bronchus intubation was noted in 2 (4%) patients after maximal head extension. Conclusion Maximal head and neck movements led to unpredictable tube displacements. Proper reassessment of tube positioning after head and neck movement of intubated patients is therefore mandatory.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2015.12.043