Jang Young-Eun, Kim Eun-Hee, Song In-Kyung, Lee Ji-Hyun, Ryu Ho-Geoul, Kim Hee-Soo, Kim Jin-Tae
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2017 Mar;96(12):e6319. doi: 10.1097/MD.0000000000006319.
Endotracheal tube (ETT) should be placed at the optimal level to avoid single lung ventilation or accidental extubation. This study was performed to estimate the mid-tracheal level by using surface anatomical landmarks in adult patients.Neck computed tomography images of 329 adult patients between the ages of 16 and 79 years were reviewed. In the midline sagittal plane, the levels corresponding to the vocal cords, cricoid cartilage, suprasternal notch, manubriosternal junction, and carina were identified. The surface distances from the cricoid cartilage to the suprasternal notch (extCC-SSN) and that from the suprasternal notch to the manubriosternal junction (extSSN-MSJ) were measured. The relationship between mid-tracheal level and the surface distances was analyzed using Bland-Altman plot.The difference between the extCC-SSN and the mid-tracheal level was -6.6 (12.5) mm, and the difference between the extSSN-MSJ and the mid-tracheal level was -19.2 (6.1) mm. The difference between the extCC-SSN and the mid-tracheal level was smaller in females compared with males [-1.7 (11.7) mm vs -12.8 (10.7) mm; P < 0.001].The mid-tracheal level, which is helpful in planning the insertion depth of an ETT, can be predicted by the surface distance between the cricoid cartilage and suprasternal notch in adults, especially in females.
气管内导管（ETT）应放置在最佳位置，以避免单肺通气或意外拔管。本研究旨在通过使用成年患者的体表解剖标志来估计气管中点水平。回顾了329例年龄在16至79岁之间的成年患者的颈部计算机断层扫描图像。在正中矢状面，确定了对应于声带、环状软骨、胸骨上切迹、胸骨柄体交界处和气管隆突的水平。测量了从环状软骨到胸骨上切迹的体表距离（extCC-SSN）以及从胸骨上切迹到胸骨柄体交界处的体表距离（extSSN-MSJ）。使用Bland-Altman图分析气管中点水平与体表距离之间的关系。extCC-SSN与气管中点水平之间的差异为-6.6（12.5）mm，extSSN-MSJ与气管中点水平之间的差异为-19.2（6.1）mm。与男性相比，女性extCC-SSN与气管中点水平之间的差异更小[-1.7（11.7）mm对-12.8（10.7）mm；P<0.001]。气管中点水平有助于规划ETT的插入深度，可通过成年患者尤其是女性的环状软骨与胸骨上切迹之间的体表距离来预测。
