Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
Department of Anaesthesia and Intensive Care, Spital Limmattal, Schlieren, Switzerland.
Paediatr Anaesth. 2021 Feb;31(2):167-177. doi: 10.1111/pan.14058. Epub 2020 Nov 17.
Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single-lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus.
The distance from the proximal end of the tracheal tube to the upper border of the cuff in cuffed tracheal tubes and to the upper margin of the Murphy eye in uncuffed tracheal tubes, respectively, was assessed in sizes 3.0-7.0 mm internal diameter. The raw data sets of two previously performed studies obtained from 337 children aged from birth to 16 years, including the distances "teeth to tracheal tube tip" and "tracheal tube tip to carina," were used to calculate age-, weight-, and height-related data for the distance from "teeth to carina." Tracheal tube dimensions were compared with age-related distances from "teeth to carina," applying published recommendations for the selection of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children.
The differences between the length of the age-related tracheal tube and the tracheal tube insertion length required to guarantee full insertion of the tracheal tube cuff or the Murphy eye within the mainstem bronchus ranged from -3.5 to 52.6 mm in cuffed tracheal tubes and from 42.3 to 83.3 mm in uncuffed tracheal tubes.
For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus.
最近有研究建议使用带套囊的气管导管进行选择性支气管内插管，以建立单肺通气，即使是在较小的儿童中也是如此。这意味着与无套囊的气管导管相比，选择的带套囊的气管导管会更小，因此长度也会更短。我们假设，如果气管导管套囊完全浸入左或右主支气管中，那么带套囊的气管导管可能长度不足，无法进行选择性支气管内插管。
分别评估内径为 3.0-7.0mm 的带套囊气管导管和无套囊气管导管中，从气管导管近端到套囊上缘和 Murphy 眼上缘的距离。使用先前在 337 名出生至 16 岁儿童中进行的两项研究的原始数据集，包括“牙齿到气管导管尖端”和“气管导管尖端到隆突”的距离，来计算与“牙齿到隆突”相关的年龄、体重和身高数据。将气管导管的尺寸与与“牙齿到隆突”相关的年龄距离进行比较，应用发表的建议选择用于儿童选择性支气管内插管的无套囊和带套囊气管导管。
带套囊气管导管中，从与年龄相关的气管导管长度到完全插入气管导管套囊或 Murphy 眼所需的气管导管插入长度的差异范围为-3.5 至 52.6mm，而无套囊气管导管中的差异范围为 42.3 至 83.3mm。
对于许多需要选择性支气管内插管的患者年龄组，与无套囊气管导管相比，带套囊气管导管的长度对于将套囊完全置于右或左主支气管内，在口腔外安全粘贴是严重不足的。
