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The Relationship between Cuff Pressure and Air Injection Volume of Endotracheal Tube: A Study with Sheep Trachea Ex Vivo. Appl Bionics Biomech 2022; 2022:1748233. [PMID: 36324632 PMCID: PMC9622272 DOI: 10.1155/2022/1748233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/13/2022] [Accepted: 05/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Endotracheal intubation is a widely used treatment. Excessive pressure of the endotracheal tube cuff leads to a series of complications. Here, we used tracheae of sheep to analyze the relationship between the air injection volume and endotracheal tube cuff pressure so as to guide the doctors and nurses in controlling the pressure of the endotracheal tube cuff during clinical work and minimise the risk of complications. Materials and Methods Forty sheep tracheae were utilised and were divided into five groups according to their diameters. Different sizes of endotracheal tubes were inserted into each trachea, and the cuff pressure with the increase of air injection volume was recorded. The formulas that reflect the relationship between air injection volume and cuff pressure were obtained. Then, sheep tracheae were randomly selected; different types of tubes were inserted, and the stipulated volume of air was injected. The actual pressure was measured and compared with the pressure predicted from the formulas. Statistical analysis was conducted to verify whether the formulas obtained from the first part of the experiment were in accordance with the expert evaluation table, which consists of opinions of several experts. Results After obtaining 15 formulas, we collected the differences between the theoretical cuff pressure and the actual cuff pressure that satisfied the expert evaluation. Relying on the formulas, the medical turntable was obtained, which is a tool that consists of two round cards with data on them. The top card has a notch. The two cards are stacked together, and as the top card rotates, the data on the bottom card can be easily seen in a one-to-one relationship. Conclusion The formulas are capable of showing the relationship between the cuff air injection volume and pressure of endotracheal tube cuff. The medical turntable can estimate the air injection volume to ensure that the pressure stays in an acceptable range.
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Tsai LW, Yuan KC, Hou SK, Wu WL, Hsu CH, Liu TL, Lee KM, Li CH, Chen HC, Tu E, Dubey R, Yeh CF, Chen RJ. Determining Carina and Clavicular Distance-Dependent Positioning of Endotracheal Tube in Critically Ill Patients: An Artificial Intelligence-Based Approach. BIOLOGY 2022; 11:490. [PMID: 35453690 PMCID: PMC9027916 DOI: 10.3390/biology11040490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
Early and accurate prediction of endotracheal tube (ETT) location is pivotal for critically ill patients. Automatic and timely detection of faulty ETT locations from chest X-ray images may avert patients' morbidity and mortality. Therefore, we designed convolutional neural network (CNN)-based algorithms to evaluate ETT position appropriateness relative to four detected key points, including tracheal tube end, carina, and left/right clavicular heads on chest radiographs. We estimated distances from the tube end to tracheal carina and the midpoint of clavicular heads. A DenseNet121 encoder transformed images into embedding features, and a CNN-based decoder generated the probability distributions. Based on four sets of tube-to-carina distance-dependent parameters (i.e., (i) 30-70 mm, (ii) 30-60 mm, (iii) 20-60 mm, and (iv) 20-55 mm), corresponding models were generated, and their accuracy was evaluated through the predicted L1 distance to ground-truth coordinates. Based on tube-to-carina and tube-to-clavicle distances, the highest sensitivity, and specificity of 92.85% and 84.62% respectively, were revealed for 20-55 mm. This implies that tube-to-carina distance between 20 and 55 mm is optimal for an AI-based key point appropriateness detection system and is empirically comparable to physicians' consensus.
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Affiliation(s)
- Lung-Wen Tsai
- Department of Medicine Research, Taipei Medical University Hospital, Taipei 11031, Taiwan;
- Department of Information Technology Office, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei 11031, Taiwan
| | - Kuo-Ching Yuan
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Surgery, Da Chien General Hospital, Miaoli 36052, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan;
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Wei-Lin Wu
- Taiwan AI Labs, Taipei 10351, Taiwan; (W.-L.W.); (C.-H.H.); (T.-L.L.); (K.-M.L.); (C.-H.L.); (H.-C.C.); (E.T.)
| | - Chen-Hao Hsu
- Taiwan AI Labs, Taipei 10351, Taiwan; (W.-L.W.); (C.-H.H.); (T.-L.L.); (K.-M.L.); (C.-H.L.); (H.-C.C.); (E.T.)
| | - Tyng-Luh Liu
- Taiwan AI Labs, Taipei 10351, Taiwan; (W.-L.W.); (C.-H.H.); (T.-L.L.); (K.-M.L.); (C.-H.L.); (H.-C.C.); (E.T.)
| | - Kuang-Min Lee
- Taiwan AI Labs, Taipei 10351, Taiwan; (W.-L.W.); (C.-H.H.); (T.-L.L.); (K.-M.L.); (C.-H.L.); (H.-C.C.); (E.T.)
| | - Chiao-Hsuan Li
- Taiwan AI Labs, Taipei 10351, Taiwan; (W.-L.W.); (C.-H.H.); (T.-L.L.); (K.-M.L.); (C.-H.L.); (H.-C.C.); (E.T.)
| | - Hann-Chyun Chen
- Taiwan AI Labs, Taipei 10351, Taiwan; (W.-L.W.); (C.-H.H.); (T.-L.L.); (K.-M.L.); (C.-H.L.); (H.-C.C.); (E.T.)
| | - Ethan Tu
- Taiwan AI Labs, Taipei 10351, Taiwan; (W.-L.W.); (C.-H.H.); (T.-L.L.); (K.-M.L.); (C.-H.L.); (H.-C.C.); (E.T.)
| | - Rajni Dubey
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Chun-Fu Yeh
- Taiwan AI Labs, Taipei 10351, Taiwan; (W.-L.W.); (C.-H.H.); (T.-L.L.); (K.-M.L.); (C.-H.L.); (H.-C.C.); (E.T.)
| | - Ray-Jade Chen
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Division of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
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Two Endotracheal Tubes in One Trachea with a Traumatic Injury. Case Rep Anesthesiol 2021; 2021:9912553. [PMID: 34055417 PMCID: PMC8131148 DOI: 10.1155/2021/9912553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Traumatic airway injuries often require improvising solutions to altered anatomy under strict time constraints. We describe here the use of two endotracheal tubes simultaneously in the trachea to facilitate securing an airway which has been severely compromised by a self-inflicted wound to the trachea. Case Presentation: A 71-year-old male presented with a self-inflicted incision to his neck, cutting deep into the trachea itself. An endotracheal tube was emergently placed through the self-inflicted hole in the trachea in the ED. The patient was bleeding profusely, severely somnolent, and desaturating upon arrival to the operating room. Preservation of the tenuous airway was a priority while seeking to establish a more secure one. A video laryngoscope was used to gain a wide view of the posterior oropharynx and assist with oral intubation using a fiberoptic scope loaded with a second endotracheal tube. The initial tube's cuff was deflated as the second tube was advanced over the fiberoptic scope, thereby securing the airway while a completion tracheostomy was performed. Conclusions Direct penetrating airway trauma may necessitate early, albeit less secure, intubations though the neck wounds prior to operating room arrival. The conundrum is weighing the risk of losing a temporary airway while attempting to establish a more secure airway. Here, we demonstrate the versatility of common anesthesia tools such as a video laryngoscope and a fiberoptic bronchoscope and the welcome discovery of the trachea's ability to accommodate two endotracheal tubes simultaneously so as to ensure a patent airway at all points throughout resuscitation.
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Karmali S, Rose P. Tracheal tube size in adults undergoing elective surgery - a narrative review. Anaesthesia 2020; 75:1529-1539. [PMID: 32415788 DOI: 10.1111/anae.15041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 12/17/2022]
Abstract
Tracheal tubes are routinely used in adults undergoing elective surgery. The size of the tracheal tube, defined by its internal diameter, is often generically selected according to sex, with 7-7.5 mm and 8-8.5 mm tubes recommended in women and men, respectively. Tracheal diameter in adults is highly variable, being narrowest at the subglottis, and is affected by height and sex. The outer diameter of routinely used tracheal tubes may exceed these dimensions, traumatise the airway and increase the risk of postoperative sore throat and hoarseness. These complications disproportionately affect women and may be mitigated by using smaller tracheal tubes (6-6.5 mm). Patient safety concerns about using small tracheal tubes are based on critical care populations undergoing prolonged periods of tracheal intubation and not patients undergoing elective surgery. The internal diameter of the tube corresponds to its clinical utility. Tracheal tubes as small as 6.0 mm will accommodate routinely used intubation aids, suction devices and slim-line fibreoptic bronchoscopes. Positive pressure ventilation may be performed without increasing the risk of ventilator-induced lung injury or air trapping, even when high minute volumes are required. There is also no demonstrable increased risk of aspiration or cuff pressure damage when using smaller tracheal tubes. Small tracheal tubes may not be safe in all patients, such as those with high secretion loads and airflow limitation. A balanced view of risks and benefits should be taken appropriate to the clinical context, to select the smallest tracheal tube that permits safe peri-operative management.
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Affiliation(s)
- S Karmali
- Department of Anaesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - P Rose
- Department of Anaesthesiology, Vancouver General Hospital, Vancouver, BC, Canada
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Massoth C, Schülke C, Köppe J, Weiss R, Pöpping D, Dahrmann M, Zarbock A, Wenk M. Nasolaryngeal Distances in the Adult Population and an Evaluation of Commercially Available Nasotracheal Tubes. Anesth Analg 2020; 130:1018-1025. [PMID: 31162158 DOI: 10.1213/ane.0000000000004241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preformed nasal endotracheal tubes (NETs) come with a predefined insertion depth due to their curved design. While size indication refers to internal diameter, there is a considerable variability in the corresponding lengths and proportions of same-sized tubes of different manufacturers which is probably based on the lack of data of nasolaryngeal distances (NLDs) in the adult population. Choosing the best-fitting NET is therefore difficult and carries the risk of endobronchial intubation or, on the contrary, cuff inflation at the vocal cord level. The aim of this study was to develop a prediction model for NLD and a selection guide to choose the appropriate NET based on a radiographic description of NLD in comparison to the measurements of available NETs of several manufacturers. METHODS After institutional ethics board review, 388 computed tomography (CT) scan images of head, neck, and upper thorax in a heterogeneous adult cohort were included. Mean distances from the nares to the lower border of the thyroid cartilage were measured. NETs from different manufacturers were measured and compared to the NLD derived from the radiographic analysis. The patients' sex, body height, and weight were considered as possible covariates in quantile regression models for predicting the NLD. RESULTS Data from 200 patients were analyzed. NLD was associated with sex, body height, and weight. A simple quantile regression model using the body height as the only covariate sufficed to achieve accurate predictions of NLD. Validation on independent test data showed that 92.8% of the NLD predictions were closer than ±20 mm to the observed NLD values. Measurements of equal-sized NETs varied considerably in outer diameter, proportion, the nasopharyngeal part, and guide marks. Length differences of the bend-to-cuff distance, containing the anatomically NLD, ranged between 218 and 270 mm at same sizes. CONCLUSIONS A reliable prediction of NLD can be obtained simply by body height, using the formula (Equation is included in full-text article.). As manufacturers' tube lengths vary substantially, additional information about the bend-to-cuff distance as corresponding tube section would allow for more accurate tube selection.
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Affiliation(s)
| | | | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University Hospital of Münster, Münster, Germany
| | - Raphael Weiss
- From the Departments of Anesthesiology and Intensive Care
| | - Daniel Pöpping
- From the Departments of Anesthesiology and Intensive Care
| | | | | | - Manuel Wenk
- From the Departments of Anesthesiology and Intensive Care
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Aljathlany Y, Aljasser A, Alhelali A, Bukhari M, Almohizea M, Khan A, Alammar A. Proposing an Endotracheal Tube Selection Tool Based on Multivariate Analysis of Airway Imaging. EAR, NOSE & THROAT JOURNAL 2020; 100:629S-635S. [PMID: 31914813 DOI: 10.1177/0145561319900390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We aimed to comprehensively investigate different upper airway segments in adults, determine the predictors of the size of each segment, and identify an appropriate endotracheal tube (ETT) size chart. STUDY DESIGN Retrospective chart review. SETTING Tertiary care center. MATERIALS AND METHODS The data for patients aged >18 years who underwent neck computed tomography were screened. Patients with existing tumors, trauma, or any pathology that can alter the normal airway anatomy and those with intubation, tracheostomy, or nasogastric tubes were excluded. Computed tomography software was used to measure the anteroposterior diameter (APD), transverse diameter (TD), and cross-sectional area (CSA) at the glottic, proximal subglottic, distal subglottic, and tracheal levels. Multiple regression analysis was used to identify the predictors of the airway size. RESULTS One hundred patients were reviewed. The TD was consistently smaller than or equal to the APD at each level in all but 3 patients. The mean CSA and TD (170 mm2 and 11.3 mm, respectively) of the glottis indicated that the glottis was most often the narrowest level, followed by the proximal subglottis where the mean CSA and TD were 192.1 mm2 and 12.7 mm, respectively. Moreover, the mean APD was the smallest at the level of the trachea (20.1 mm). Multiple regression analysis confirmed that height and sex were the predominant predictors of measurements for the 4 airway segments. In addition, age was associated with the TD and CSA of the distal subglottic and tracheal segments, respectively. CONCLUSION One-third of our participants exhibited a proximal subglottic diameter that was equal to or smaller than the glottic diameter. Our findings also suggested that the height and sex of the patients are important variables for the selection of an appropriate ETT size.
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Affiliation(s)
- Yousef Aljathlany
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aljasser
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alhelali
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Manal Bukhari
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed Almohizea
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Adeena Khan
- Department of Radiology, 191082King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alammar
- Otolaryngology, Head and Neck Surgery Department, 191082King Saud University Medical City, Riyadh, Saudi Arabia
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