Sood Amit, Taheri M Reza, Joshi Arjun S
Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA.
Department of Diagnostic Radiology, George Washington University, Washington, DC, USA.
Ann Otol Rhinol Laryngol. 2014 Sep;123(9):654-7. doi: 10.1177/0003489414528866. Epub 2014 Apr 4.
The objective of our study is to describe the technique of distal endotracheal tube (ETT) positioning for avoiding cuff rupture and validate the technique in a virtual tracheostomy model.
A prospective nonrandomized case series of 129 patients who had undergone tracheostomy using the senior author's technique were evaluated. Primary outcome was ETT cuff rupture. One hundred normal patient computed tomography (CT) scans were used to generate a virtual tracheostomy model, and the probability of cuff rupture, among other values, was obtained.
One hundred twenty-three of 129 patients underwent tracheostomy without cuff rupture when the distal tip of the ETT was placed just proximal to the carina. After analysis of 100 3-dimensional CT scans, the average distance from the tracheotomy to the superior aspect of the cuff was 54.6 mm in men and 39.87 mm in women when a 6.5-size ETT was used, and 44.8 mm in men and 30.07 mm in women when a 7.5-size ETT was used. Virtual tracheotomy between the second and third tracheal rings resulted in no probability of inadvertent ETT cuff rupture.
Distal ETT positioning during tracheostomy should be considered for avoiding inadvertent ETT cuff rupture.
我们研究的目的是描述远端气管内插管（ETT）定位技术以避免套囊破裂，并在虚拟气管造口模型中验证该技术。
对129例采用资深作者技术进行气管造口术的患者进行前瞻性非随机病例系列评估。主要结局是ETT套囊破裂。使用100例正常患者的计算机断层扫描（CT）生成虚拟气管造口模型，并获得套囊破裂的概率等数值。
当ETT远端尖端置于隆突近端时，129例患者中有123例进行气管造口术时未发生套囊破裂。在分析100例三维CT扫描后，使用6.5号ETT时，男性从气管切开处到套囊上缘的平均距离为54.6 mm，女性为39.87 mm；使用7.5号ETT时，男性为44.8 mm，女性为30.07 mm。在第二和第三气管环之间进行虚拟气管切开术不会导致ETT套囊意外破裂。
气管造口术期间应考虑远端ETT定位以避免ETT套囊意外破裂。
