Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures
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Objectives. Postintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tube sizes), and to explain the context, why small women are particularly susceptible to PTR. Methods. Experimental study performed on 28 fresh human laryngotracheal specimens (16 males, 12 females) within 24 hours post autopsy. Artificial ventilation was simulated by using an underwater construction and a standard tracheal tube. Tube sizes were selected according to our previously published nomogram. Tracheal lesions were detected visually and tracheal diameters measured. The influence of body size, sex difference and appropriate tube size were investigated according to patient height. Results. In all 28 cases, the typical tracheal lesion pattern was a longitudinal median rupture of the posterior trachea. Appropriate tube sizes according to body size caused PTR with significantly higher cuff pressure when compared with oversized tubes. An increased risk of PTR was found in shorter patients, when oversized tubes were used. Sex difference did not have any significant influence. Conclusion. This experimental model provides information about tracheal patterns in PTR for the first time. The model confirms by experiment the observations of case series in PTR patients, and therefore emphasizes the importance of correct tube size selection according to patient height. This minimizes the risk of PTR, especially in shorter patients, who have an increased risk of PTR when oversized tubes are used.
Abstract
Objectives. Postintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tube sizes), and to explain the context, why small women are particularly susceptible to PTR. Methods. Experimental study performed on 28 fresh human laryngotracheal specimens (16 males, 12 females) within 24 hours post autopsy. Artificial ventilation was simulated by using an underwater construction and a standard tracheal tube. Tube sizes were selected according to our previously published nomogram. Tracheal lesions were detected visually and tracheal diameters measured. The influence of body size, sex difference and appropriate tube size were investigated according to patient height. Results. In all 28 cases, the typical tracheal lesion pattern was a longitudinal median rupture of the posterior trachea. Appropriate tube sizes according to body size caused PTR with significantly higher cuff pressure when compared with oversized tubes. An increased risk of PTR was found in shorter patients, when oversized tubes were used. Sex difference did not have any significant influence. Conclusion. This experimental model provides information about tracheal patterns in PTR for the first time. The model confirms by experiment the observations of case series in PTR patients, and therefore emphasizes the importance of correct tube size selection according to patient height. This minimizes the risk of PTR, especially in shorter patients, who have an increased risk of PTR when oversized tubes are used.
참고문헌 (30)
- Minambres E, "Tracheal rupture after endotracheal intubation: a literature systematic review", Eur J Cardiothorac Surg, 35(6), pp.1056~1062 (2009)
- Conti M, "Management of postintubation tracheobronchial ruptures", Chest, 130(2), pp.412~418 (2006)
- Cardillo G, "Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment", Eur J Cardiothorac Surg, 37(3), pp.581~587 (2010)
- Chen EH, "A case of tracheal injury after emergent endotracheal intubation: a review of the literature and causalities", Anesth Analg, 93(5), pp.1270~1271 (2001)
- 임형선, "Tracheal rupture after endotracheal intubation - A report of three cases -", Korean Journal of Anesthesiology, 62(3), pp.277~280 (2012), 대한마취통증의학회
- Wagner A, "Tracheal rupture after emergency intubation during cardiopulmonary resuscitation", Resuscitation, 30(3), pp.263~266 (1995)
- Schedlbauer EM, "Iatrogenic tracheal rupture in children: a retrospective study", Laryngoscope, 119(3), pp.571~575 (2009)
- Weiss M, "Shortcomings of cuffed paediatric tracheal tubes", Br J Anaesth, 92(1), pp.78~88 (2004)
- Randestad A, "Dimensions of the cricoid cartilage and the trachea", Laryngoscope, 110(11), pp.1957~1961 (2000)
- Medina CR, "Post-intubation tracheal injury: report of three cases and literature review", J Bras Pneumol, 35(8), pp.809~813 (2009)
- Marty-Ane CH, "Membranous tracheal rupture after endotracheal intubation", Ann Thorac Surg, 60(5), pp.1367~1371 (1995)
- Sippel M, "Tracheal rupture after endotracheal intubation: experience with management in 13 cases", Thorac Cardiovasc Surg, 54(1), pp.51~56 (2006)
- Seegobin RD, "Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs", Br Med J (Clin Res Ed), 288(6422), pp.965~968 (1984)
- Guyton D, "High-volume, low-pressure cuffs. Are they always low pressure?", Chest, 100(4), pp.1076~1081 (1991)
- Sengupta P, "Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure", BMC Anesthesiol, 4(1), pp.8~ (2004)
- Hoffman RJ, "Experienced emergency medicine physicians cannot safely inflate or estimate endotracheal tube cuff pressure using standard techniques", Am J Emerg Med, 24(2), pp.139~143 (2006)
- Michlig SA., "Anaesthetic staff cannot identify extremely high tracheal tube cuff pressures by palpation of the pilot balloon", Br J Anaesth, 111(2), pp.300~301 (2013)
- Li Bassi G, "An in vitro study to assess determinant features associated with fluid sealing in the design of endotracheal tube cuffs and exerted tracheal pressures", Crit Care Med, 41(2), pp.518~526 (2013)
- Ulrich-Pur H, "Comparison of mucosal pressures induced by cuffs of different airway devices", Anesthesiology, 104(5), pp.933~938 (2006)
- Horisberger T, "Measurement of tracheal wall pressure: a comparison of three different in vitro techniques", Anaesthesia, 63(4), pp.418~422 (2008)
- Striebel HW, "Tracheal rupture caused by overinflation of endotracheal tube cuff", Anaesthesist, 44(3), pp.186~188 (1995)
- Seidl RO, "Tracheal ruptures in endotracheal intubation: diagnosis and therapy", HNO, 50(2), pp.134~138 (2002)
- Stannard K, "Tracheal rupture following endotracheal intubation", Anaesth Intensive Care, 31(5), pp.588~591 (2003)
- Coordes A, "Selection and placement of oral ventilation tubes based on tracheal morphometry", Laryngoscope, 121(6), pp.1225~1230 (2011)
- Dullenkopf A, "Nitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs", Acta Anaesthesiol Scand, 48(9), pp.1180~1184 (2004)
- Chadha NK, "Automated cuff pressure modulation: a novel device to reduce endotracheal tube injury", Arch Otolaryngol Head Neck Surg, 137(1), pp.30~34 (2011)
- Massard G, "Tracheobronchial lacerations after intubation and tracheostomy", Ann Thorac Surg, 61(5), pp.1483~1487 (1996)
- Lampl L, "Tracheobronchial injuries: conservative treatment", Interact Cardiovasc Thorac Surg, 3(2), pp.401~405 (2004)
- Gordin A, "An animal model for endotracheal tube-related laryngeal injury using hypoxic ventilation", Otolaryngol Head Neck Surg, 144(2), pp.247~251 (2011)
- Foroulis CN, "Pericardial patch repair of an extensive longitudinal iatrogenic rupture of the intrathoracic membranous trachea", Interact Cardiovasc Thorac Surg, 2(4), pp.595~597 (2003)