Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study.
Bronchial intubation
Malposition of tracheal tube
Tracheal diverticulum
Tracheal intubation
Tracheal tube
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
25 Nov 2023
25 Nov 2023
Historique:
received:
04
06
2023
accepted:
18
11
2023
medline:
27
11
2023
pubmed:
26
11
2023
entrez:
25
11
2023
Statut:
epublish
Résumé
Incomplete sealing of tracheal diverticula by a tracheal tube cuff during positive-pressure ventilation causes barotrauma but the concrete possibility of incomplete sealing has not been indicated. We aimed to assess the possibility of incomplete sealing in a simulated situation of tracheal intubation for patients with tracheal diverticula with tube fixation where the tracheal tube's vocal cord guide overlaps with the patient's vocal cord. We retrospectively assessed the characteristics of tracheal diverticula based on thoracic computed tomography data in our institution from January 2018 to July 2020. Then, we assessed the structural parameters of three single-lumen tracheal tubes (Parker Flex-Tip [Parker Medical, Bridgewater, CT, USA], Portex Soft Seal [ICU Medical, San Clemente, CA, USA], and Shiley TaperGuard [Medtronic, Dublin, Ireland]; 6.0-8.0 mm inner diameter size) and simulated the positional relationships between tracheal diverticula and the tracheal tube during tracheal intubation where the vocal cord guide overlaps with the patient's vocal cord. We assessed each tube product's possibility of incompletely sealing tracheal diverticula and the possibility of unintended bronchial intubation. In 5,854 patients, the prevalence of tracheal diverticula was 5.7%. The mean (SD) length from the vocal cord to the distal end of the tracheal diverticula was 52.2 (12.8) mm. Tracheal tubes with length from the distal end of the tracheal cuff to the vocal cord guide of ≥ 70 mm had a low risk of incompletely sealing tracheal diverticula (< 5%) and length from the distal end of the tube to the vocal cord guide of ≤ 95 mm had a low risk of unintended bronchial intubation (< 5%). No products in this study satisfied both outcomes. Tube fixation, where the vocal cord guide overlaps with the patient's vocal cord, is associated with risk of incompletely sealing of tracheal diverticula depending on the tube's manufacturer and tube's inner diameter size, although it was not a high risk. The use of small inner diameter sized tube relative to patient's body size is high risk of incomplete sealing of tracheal diverticula. This trial was prospectively registered at University Hospital Medical Information Network (UMIN). UMIN000043317 (URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048055 ).
Sections du résumé
BACKGROUND
BACKGROUND
Incomplete sealing of tracheal diverticula by a tracheal tube cuff during positive-pressure ventilation causes barotrauma but the concrete possibility of incomplete sealing has not been indicated. We aimed to assess the possibility of incomplete sealing in a simulated situation of tracheal intubation for patients with tracheal diverticula with tube fixation where the tracheal tube's vocal cord guide overlaps with the patient's vocal cord.
METHODS
METHODS
We retrospectively assessed the characteristics of tracheal diverticula based on thoracic computed tomography data in our institution from January 2018 to July 2020. Then, we assessed the structural parameters of three single-lumen tracheal tubes (Parker Flex-Tip [Parker Medical, Bridgewater, CT, USA], Portex Soft Seal [ICU Medical, San Clemente, CA, USA], and Shiley TaperGuard [Medtronic, Dublin, Ireland]; 6.0-8.0 mm inner diameter size) and simulated the positional relationships between tracheal diverticula and the tracheal tube during tracheal intubation where the vocal cord guide overlaps with the patient's vocal cord. We assessed each tube product's possibility of incompletely sealing tracheal diverticula and the possibility of unintended bronchial intubation.
RESULTS
RESULTS
In 5,854 patients, the prevalence of tracheal diverticula was 5.7%. The mean (SD) length from the vocal cord to the distal end of the tracheal diverticula was 52.2 (12.8) mm. Tracheal tubes with length from the distal end of the tracheal cuff to the vocal cord guide of ≥ 70 mm had a low risk of incompletely sealing tracheal diverticula (< 5%) and length from the distal end of the tube to the vocal cord guide of ≤ 95 mm had a low risk of unintended bronchial intubation (< 5%). No products in this study satisfied both outcomes.
CONCLUSIONS
CONCLUSIONS
Tube fixation, where the vocal cord guide overlaps with the patient's vocal cord, is associated with risk of incompletely sealing of tracheal diverticula depending on the tube's manufacturer and tube's inner diameter size, although it was not a high risk. The use of small inner diameter sized tube relative to patient's body size is high risk of incomplete sealing of tracheal diverticula.
TRIAL REGISTRATION
BACKGROUND
This trial was prospectively registered at University Hospital Medical Information Network (UMIN).
CLINICAL TRIAL NUMBER AND REGISTRY URL
BACKGROUND
UMIN000043317 (URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048055 ).
Identifiants
pubmed: 38007426
doi: 10.1186/s12871-023-02347-y
pii: 10.1186/s12871-023-02347-y
pmc: PMC10675875
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
386Informations de copyright
© 2023. The Author(s).
Références
Acta Med Litu. 2021;28(2):302-307
pubmed: 35474930
J Crit Care Med (Targu Mures). 2015 Nov 10;1(4):171-173
pubmed: 29967827
Eurasian J Med. 2013 Oct;45(3):145-8
pubmed: 25610271
Acta Anaesthesiol Scand. 2007 Feb;51(2):235-8
pubmed: 17181537
Eur Respir J. 1994 Jul;7(7):1376-7
pubmed: 7925920
Anaesthesia. 1995 Aug;50(8):682-7
pubmed: 7645696
Diagn Interv Radiol. 2015 Jan-Feb;21(1):42-6
pubmed: 25430529
Jpn J Radiol. 2011 Nov;29(9):644-8
pubmed: 21956370
Anaesthesia. 2013 Apr;68(4):432-3
pubmed: 23488851
Medicine (Baltimore). 2018 Sep;97(39):e12544
pubmed: 30278548
AJNR Am J Neuroradiol. 2008 Jun;29(6):1218-21
pubmed: 18544671
J Thorac Dis. 2022 Nov;14(11):4276-4284
pubmed: 36524079
AJR Am J Roentgenol. 1999 Jul;173(1):65-70
pubmed: 10397101
Gen Thorac Cardiovasc Surg. 2020 Sep;68(9):1018-1023
pubmed: 32748198
Br J Anaesth. 2018 Aug;121(2):490-495
pubmed: 30032890
Emerg Med J. 2022 Jul;39(7):534-539
pubmed: 34376465
J Thorac Imaging. 2011 Aug;26(3):204-8
pubmed: 20818276
J Cardiothorac Vasc Anesth. 2003 Jun;17(3):355-6
pubmed: 12827586
Anesthesiology. 1992 Sep;77(3):586-7
pubmed: 1519795
Eur Radiol. 2010 Jan;20(1):88-94
pubmed: 19597819
Korean J Anesthesiol. 2010 Oct;59(4):249-55
pubmed: 21057614
Braz J Anesthesiol. 2017 Mar - Apr;67(2):214-216
pubmed: 28236872
Masui. 2013 Jun;62(6):678-81
pubmed: 23814990
Intensive Care Med. 2019 Feb;45(2):259-260
pubmed: 30043274
Radiol Med. 2008 Mar;113(2):181-9
pubmed: 18386120
Saudi J Anaesth. 2012 Jul;6(3):259-62
pubmed: 23162400
Sci Rep. 2021 Jan 26;11(1):2168
pubmed: 33500472
Br J Radiol. 2013 Jan;86(1021):20120218
pubmed: 23255540
Clin Anat. 2009 Jul;22(5):571-9
pubmed: 19544298
Can J Anaesth. 2016 Sep;63(9):1098-9
pubmed: 27053194
Monaldi Arch Chest Dis. 2016 Jun 22;81(1-2):743
pubmed: 27374216
BMJ Case Rep. 2016 Sep 27;2016:
pubmed: 27677578
A A Pract. 2020 Jul;14(9):e01262
pubmed: 32909716