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Cathelain G, Perrier A, Folliot L, Le Gloanec C, Rarrbo M, Jouen F, Saudeau E, Costa G, Carlier R, Bergounioux J. Bench testing of tracheostomy tube-related insults using an instrumented manikin. Eur Arch Otorhinolaryngol 2021; 279:1593-1599. [PMID: 34499203 DOI: 10.1007/s00405-021-07054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Choosing the right tracheal tube for the right patient is a daily preoccupation for intensivists and emergency physicians. Tracheal tubes can generate severe complications, which are chiefly due to the pressures applied by the tube to the trachea. We designed a bench study to assess the frequency of pressure levels likely to cause tracheal injury. METHODS We tested the pressure applied on the trachea by 17 tube models of a given size range. To this end, we added a pressure sensor to the posterior tracheal wall of a standardized manikin. RESULTS Only 2 of the 17 tubes generated pressures under the threshold likely to induce tracheal injury (30 mmHg/3.99 kPa). The force exerted on the posterior wall of the trachea varied widely across tube models. CONCLUSION Most models of tracheal tubes resulted in forces applied to the trachea that are usually considered capable of causing tracheal tissue injury. LEVEL OF EVIDENCE Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence: How common is the problem?: step 1; Is this diagnostic or monitoring test accurate? (Diagnosis) step 5; What will happen if we do not add a therapy? (Prognosis) n/a; Does this intervention help? (Treatment Benefits) step 5; What are the COMMON harms?(Treatment Harms) step 5; What are the RARE harms? (Treatment Harms) step 5; Is this (early detection) test worthwhile? (Screening) step 5.
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Affiliation(s)
- Guillaume Cathelain
- CHArt Laboratory, Ecole Pratique Des Hautes Etudes, PSL University, Paris, France
| | - Antoine Perrier
- Université Grenoble Alpes and CNRS, TIMC-IMAG, 38000, Grenoble, France.,Pitié-Salpêtrière Teaching Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Ludivine Folliot
- DMU Smart Imaging, Radiology Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - Cyrielle Le Gloanec
- Clinical Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - Mohamed Rarrbo
- Clinical Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - François Jouen
- CHArt Laboratory, Ecole Pratique Des Hautes Etudes, PSL University, Paris, France
| | - Etienne Saudeau
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Guillaume Costa
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Robert Carlier
- DMU Smart Imaging, Radiology Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Jean Bergounioux
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France. .,Simone Veil Health Science Centre, Université Versailles SQY, Paris-Saclay, Versailles, France. .,Réanimation et Soins Intensifs Pédiatriques, Batiment Letulle, 3ème étage, Hôpital Universitaire Raymond Poincaré, APHP, 104 Boulevard Raymond Poincaré, Garches, 92380, Paris, France.
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[Pediatric tracheotomy]. HNO 2012; 60:581-9. [PMID: 22622357 DOI: 10.1007/s00106-011-2383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Tracheotomies are increasingly performed in the pediatric population in the context of long-term treatment. There are specific pediatric aspects that require attention: differences in the pediatric compared to adult anatomy, the necessity for later reconstruction and the negative impact on oral feeding and speech development. Caring for pediatric tracheostomy patients is more challenging compared to adult patients. This needs to be addressed by a dedicated team during both in- and outpatient treatment.
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