Elongation of the Trachea During Neck Extension in Children: Implications of the Safety of Endotracheal Tubes
- 1 October 2005
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 101 (4), 974-977
- https://doi.org/10.1213/01.ane.0000169330.92707.1e
Abstract
During neck extension, the changes in distance between endotracheal tube (ETT) tip and carina may not be equal to the changes in distance between vocal cords and ETT tip because of tracheal elongation. These distances are directly related to extubation risk. Using a fiberoptic bronchoscope, the distance between ETT tip and carina was measured in the neutral position after full extension of the neck in 25 children (2–8 yr old) scheduled for elective surgery under general anesthesia. The tracheal length was then measured in the neutral position and after full extension. The distance between vocal cords and ETT tip was calculated as the tracheal length minus the distance between ETT tip and carina. After full extension, the tracheal length (7.97 ± 0.85 cm) was increased by 0.95 ± 0.43 cm, and the change in distance between vocal cords and ETT tip was −1.08 ± 0.47 cm, whereas the change in distance between ETT tip and carina was 2.02 ± 0.58 cm. These results suggest that neck extension actually displaces the ETT tip to the vocal cords, increasing the risk of tracheal extubation in older children, although the actual displacement of ETT tip to vocal cords is reduced by tracheal lengthening.Keywords
This publication has 10 references indexed in Scilit:
- Use of an optical fiber scope to confirm endotracheal tube placement in pediatric patientsCritical Care Medicine, 2001
- Effect of neck position on endotracheal tube location in low birth weight infantsPediatric Pulmonology, 1999
- Magnetic Resonance Imaging Determination of Tracheal Orientation in Normal Children: Practical ImplicationsJAMA Otolaryngology–Head & Neck Surgery, 1996
- Movement of oral and nasal tracheal tubes as a result of changes in head and neck positionAnaesthesia, 1995
- Complications of endotracheal intubation and mechanical ventilation in infants and childrenCritical Care Medicine, 1992
- Instability of the tracheal tube in neonatesAnaesthesia, 1989
- Radioanatomy of upper airways in flexion and retroflexion of the neckNeuroradiology, 1988
- Dimensions of the growing trachea related to age and genderAmerican Journal of Roentgenology, 1986
- Alteration of endotracheal tube position Flexion and extension of the neckCritical Care Medicine, 1976
- Endotracheal tube position in the infantThe Journal of Pediatrics, 1971