JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yoo, S.-Y.
Right arrow Articles by Oh, A.-Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yoo, S.-Y.
Right arrow Articles by Oh, A.-Y.
Related Collections
Right arrow Airway
Right arrow Pediatrics

Anesth Analg 2007;105:620-625
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000278149.66027.0b

PEDIATRIC ANESTHESIOLOGY

A Comparative Study of Endotracheal Tube Positioning Methods in Children: Safety from Neck Movement

Seung-Yeon Yoo, MD*, Jin-Hee Kim, MD, PhD*{dagger}, Sung-Hee Han, MD, PhD*{dagger}, and Ah-Young Oh, MD, PhD{dagger}

From the *Department of Anesthesiology, Seoul National University Medical College, Seoul, Korea, {dagger}Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam City, Kyeonggi-do, Korea.

Address correspondence and reprint requests to Jin-Hee Kim, MD, Department of Anesthesiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Seongnam City, Kyeonggi-do, 463-802, Korea. Address e-mail to anesing1{at}snu.ac.kr.

Abstract

BACKGROUND: The unexpected displacement of the endotracheal tube (ETT) as a result of neck movements can cause endobronchial intubation and accidental extubation. The ETT is subject to movement even after its proper placement has been confirmed either clinically or radiographically.

METHODS: One-hundred-seven children (2–8 yr) were divided randomly into three groups. In Group I, the ETT was entered into the main bronchus and withdrawn until equal sounds in both lung were heard, and then withdrawn 2 cm. In Group II, the ETT position was determined by placing the prescribed marks on the ETT at the level of the vocal cords, and in Group III, by palpating the ETT tip at the suprasternal notch. In all groups, the distance between the ETT tip and the carina was measured using a fiberoptic bronchoscope. The relative ETT tip position along the trachea (carina; 0%, vocal cords; 100%) was assessed in each position during neck movement.

RESULTS: The relative position of the ETT with the patient in the neutral position in Groups I, II, and III was 21.4% ± 6.7%, 46.5% ± 13.0%, and 43.4% ± 11.1%, respectively. In Group I, the relative ETT position after flexion was 9.5% ± 10.3%, and endobronchial intubation was observed in five children (14.3%). There was no extubation or endobronchial intubation in the other two groups.

CONCLUSIONS: Positioning the ETT by auscultation places the ETT more deeply than the midtrachea, which can increase the risk of endobronchial intubation during neck flexion.




This article has been cited by other articles:


Home page
 JWatch Emergency Med.Home page
Best Method for Placing Pediatric Tubes to the Correct Depth
Journal Watch Emergency Medicine, October 5, 2007; 2007(1005): 1 - 1.
[Full Text]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.