BJA Advance Access originally published online on February 7, 2006
British Journal of Anaesthesia 2006 96(4):486-491; doi:10.1093/bja/ael014
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Tracheal tube-tip displacement in children during head-neck movement—a radiological assessment
1Department of Anaesthesia, University Children's Hospital Zurich, Switzerland
2Department of Cardiology, University Children's Hospital Zurich, Switzerland
3Department of Congenital Heart Disease, German Heart Centre Berlin, Germany
*Corresponding author: Department of Anaesthesia, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland. E-mail: markus.weiss{at}kispi.unizh.ch
Background. Aims of this study were to assess the maximum displacement of tracheal tube tip during head-neck movement in children, and to evaluate the appropriateness of the intubation depth marks on the Microcuff Paediatric Endotracheal Tube regarding the risk of inadvertent extubation and endobronchial intubation.
Methods. We studied children, aged from birth to adolescence, undergoing cardiac catheterization. The patients' tracheas were orally intubated and the tracheal tubes positioned with the intubation depth mark at the level of the vocal cords. The tracheal tube tip-to-carina distances were fluoroscopically assessed with the patient supine and the head-neck in 30° flexion, 0° neutral position and 30° extension.
Results. One hundred children aged between 0.02 and 16.4 yr (median 5.1 yr) were studied. Maximum tracheal tube-tip displacement after head-neck 30° extension and 30° flexion demonstrated a linear relationship to age [maximal upward tube movement (mm)=0 0.71xage (yr)+9.9 (R2=0.893); maximal downward tube movement (mm)=0.83xage (yr)+9.3 (R2=0.949)]. Maximal tracheal tube-tip downward displacement because of head-neck flexion was more pronounced than upward displacement because of head-neck extension.
Conclusions. The intubation depth marks were appropriate to avoid inadvertent tracheal extubation and endobronchial intubation during head-neck movement in all patients. However, during head-neck extension the tracheal tube cuff may become positioned in the subglottic region and should be re-adjusted when the patient remains in this position for a longer time.
Declaration of interest. The tracheal tubes studied were ordered from a local distributor. No financial support was obtained from the manufacturer for the presented study. M.W. is involved in designing paediatric tracheal tube cuffs made from polyurethane in co-operation with Microcuff GmbH, Weinheim, Germany and TYCO Health Care, R&D Athlone, Ireland. No agreements or financial benefits arise from these co-operations.
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