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Electronic Letters to:

Clinical Investigation:
M. Weiss, W. Knirsch, O. Kretschmar, A. Dullenkopf, M. Tomaske, C. Balmer, K. Stutz, A. C. Gerber, and F. Berger
Tracheal tube-tip displacement in children during head-neck movement--a radiological assessment{dagger}
Br. J. Anaesth. 2006; 0: ael014v1 [Abstract] [PDF]
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Electronic letters published:

[Read E-letter] Endotracheal tube displacement with head positioning
K.S Ramabhadran   (11 July 2006)

Endotracheal tube displacement with head positioning 11 July 2006
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K.S Ramabhadran,
SHO in Anaesthetics
Huddersfield Royal Infirmary

Send letter to journal:
Re: Endotracheal tube displacement with head positioning

I read, with interest, this article about Tracheal tube-tip displacement in children during head-neck movement—a radiological assessment

As correctly mentioned in the article the risk of accidental extubation and endobroncheal intubation with change in head posture is more in children because of short trachea which decreases the margin of safety. This risk is further increased in patients with a number of syndromes, including DiGeorge anomaly and several types of congenital heart disease and skeletal dysplasias, meningomyelocoele because of short trachea as compaired to normal children(1)

Endotracheal tube displacement with head-neck movements are not only seen during operative procedures on head and neck but also during diagnostic procedures like chest X-ray in critically ill patient, during resuscitation (2) or simple mouth opening of infants (3)

Head–neck movement can cause endotracheal tube displacement as well as significant increase or decrease in intracuff pressure and volume of endotracheal tube during flexion or extension respectively (4,5,6) or blockage of endotracheal tube orifice by abutting against tracheal wall which has its own complications(7)

As we know prevention is better than cure, so anticipation and proper precautions can prevent life threatening consequences

References:

1.Pediatr Neurol.1990 Mar-Apr;6(2):109-11.

Incidence of short trachea in patients with

myelomeningocele

2.Aust Crit Care. 2000 Mar;13(1):6-8.

Endotracheal tube stability in the resuscitation

environment

3.Anaesthesia. 1989 Feb;44(2):107-9.

Instability of the tracheal tube in neonates.

A postmortem study

4.Masui.1998 Sep;47(9):1069-72

Effects of changes in head and neck position on a

tracheal tube cuff

5.Br J Anaes 1999 May;82(5):708-11

Direct measurement of mucosal pressures exerted by cuff

and non-cuff portions of tracheal tubes with different

cuff volumes and head and neck positions

6.Can Anaesth Soc J.1985 Jul;32(4):326-9

Factors affecting leak around tracheal tubes in children

7.Radiology.1981 Nov;141(2):387-91

Endotracheal tube orifice abutting the tracheal wall:

a cause of infant airway obstruction

Conflict of Interest:

None declared