A controlled trial to investigate whether the orientation of the bevel and angle of approach determine the side of endobronchial intubation in an adult manikin

2019 ◽  
Vol 30 (3) ◽  
pp. 63-68
Author(s):  
SR Dawson ◽  
PM McConaghy ◽  
RC Barr
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Main Bronchus ◽  
Controlled Trial ◽  
Acute Angle ◽  
Common Reason ◽  
Endobronchial Intubation ◽  
High Incidence ◽  
Laryngoscope Blades ◽  
The Right

One of the commonest complications of endotracheal intubation occurs when the tip of the endotracheal tube passes distal to the carina and enters one of the main bronchi. The perioperative practitioner may observe high airway pressures, hypoxia or even pneumothorax. The most common reason given for the high incidence of right endobronchial intubation is that the right main bronchus comes off the trachea at a more acute angle from the midline. We sought, however, to explore two other factors which may explain this phenomenon – the angle of the tube’s bevel and its trajectory of approach. We conducted a prospective controlled trial in which doctors from our department intubated the trachea of an adult manikin in three distinct sets using standard tube, reversed tubes and reversed laryngoscope blades. We found that the angle of the bevel and trajectory of approach determines the side of endobronchial intubation in an adult manikin.

A New System for Location of Endotracheal Tube in Preterm and Term Neonates

PEDIATRICS ◽  
1991 ◽  
Vol 87 (1) ◽  
pp. 44-47
Author(s):  
Marc Blayney ◽  
Simon Costello ◽  
Max Perlman ◽  
Kel Lui ◽  
John Frank
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Controlled Trial ◽  
Standard Technique ◽  
Term Neonates ◽  
Clinical Method ◽  
Unplanned Extubations ◽  
Initial Placement ◽  
The Right ◽  
New System

A randomized, controlled trial was conducted to evaluate a new noninvasive system for placement of the endotracheal tube, based on a magnetic field interference-sensing technique. Seventy-two neonates treated by the standard technique were compared with 70 treated by the new system (TRACH MATE), with radiographic localization as the standard. As judged by the author(s) on the morning after the intubation, correct initial placement was achieved in 69 (78%) of 88 intubations using the new system, compared with 71 (66%) of 107 using the standard technique (Fisher's Test, one-tailed, P = .044). Repositioning was actually done in 23 (26%) of 88 TRACH MATE intubations, compared with 42 (39%) of 107 standard intubations (Fisher's test, one-tailed; P = .037). Intubation of the right main bronchus occurred in 7 standard intubations, but in none of the TRACH MATE intubations (Fisher's test, one-tailed; P = .014). Endotracheal tube position (high, low, or appropriate) was correctly determined by TRACH MATE in 77 (90%) of 85 intubations; the position was not recorded on three occasions. No differences in the number of complications (eg, unplanned extubations, distal displacement, subglottic stenosis) were found between the two groups. It is concluded that the TRACH MATE technique is superior to the standard clinical method in initial placement of the endotracheal tube.

Velocity profiles in central airways with endotracheal intubation: a model study

1986 ◽  
Vol 60 (3) ◽  
pp. 876-884 ◽  
Author(s):  
A. S. Menon ◽  
M. E. Weber ◽  
H. K. Chang
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Particle Deposition ◽  
Main Bronchus ◽  
Velocity Profiles ◽  
Left Main Bronchus ◽  
Scale Model ◽  
Left Main ◽  
Lobar Bronchus ◽  
The Right

Steady inspiratory velocity profiles were measured at two flow rates in a 3:1 scale model of the human central airways in the presence of five modes of endotracheal intubation. The presence of an orifice or a short endotracheal tube had no significant effect on the velocity profiles distal to the carina. Long endotracheal tubes change the profiles in both main bronchi. A significant peak occurred in the frontal plane near the walls, and the maximum velocity in the airway was almost identical to the endotracheal tube center-line velocity. The flow impinging on the medial wall of the main bronchus was redirected up around the anterior and posterior walls yielding bipeak velocity profiles in the sagittal plane. A tube placed eccentrically in the trachea over the right main bronchus did not alter the velocity profiles in the left main bronchus, suggesting a redirection of flow over the carina into the left lung. An endobronchial tube at the mouth of the right main bronchus did change the shape of the velocity profiles in the left main bronchus. In the left upper lobar bronchus the presence of trachea intubation had no effect on the velocity profiles. However, in the right upper lobar bronchus, the long endotracheal tube flattened the velocity profiles from the strongly skewed ones seen in the absence of the endotracheal inserts. These results not only are relevant to distribution of ventilation and aerosol particle deposition, but also have strong implications in intrapulmonary gas mixing, especially when high-frequency low tidal-volume ventilation is involved.

scholarly journals Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

1975 ◽  
Vol 3 (3) ◽  
pp. 209-217 ◽  
Author(s):  
G. C. Fisk ◽  
W. de C. Baker
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Squamous Metaplasia ◽  
Nasotracheal Intubation ◽  
Newborn Infants ◽  
Respiratory Epithelium ◽  
Lower Trachea ◽  
Nasotracheal Tube ◽  
Mucosal Changes ◽  
The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

scholarly journals Is there an optimal place to hold the endotracheal tube during direct laryngoscopy? Protocol for a Randomised Controlled Trial

2021 ◽  
Author(s):  
Manisha Sahoo ◽  
Swagata Tripathy ◽  
Nitasha Mishra
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Controlled Trial ◽  
Scientific Evidence ◽  
Intubation Difficulty ◽  
The Mean ◽  
Randomised Controlled ◽  
Difficulty Score ◽  
Clinical Trials Registry ◽  
Rate Of Success

Abstract Background: Laryngoscopic endotracheal intubation (LEI) is a widely performed lifesaving technique. There are evidence and guidelines to help decide the optimal sized endotracheal tube (ET), laryngoscope, depth of insertion, and patient position for successful endotracheal intubation. We hypothesize that after glottic visualization, the point at which the ET is held will affect the time, ease, and success of the technique due to a difference in visualization and torque. We aim to compare two sites of holding the ET after optimal laryngeal-inlet visualization: time to intubation, rate of success of first pass intubation, intubation difficulty and complications.Methods: Supervised intubations on ASA 1-2 patients (>18 years) posted for surgery under general anesthesia performed by anesthesia trainees (experience <18 months) will be included. Patients with an anticipated difficult airway or unanticipated difficulty - CL grade > three or requiring the use of airway adjuncts will be excluded. A computer-generated numbers list will randomize patients; allocation concealed with opaque sealed envelopes. ET marked at the selected site will be handed to the intubator by the theatre-technician once she/he confirms the optimum laryngoscopic view. The entire procedure will be video recorded. Two blinded assessors will independently review the videos to document the time to intubation (TTI defined as the time from holding the ET to the removal of laryngoscope from the mouth after successful intubation) and intubation difficulty score. Postoperative sore throat and hoarseness will be recorded.Sample size: 54 experienced anesthetists were video-recorded during intubating. The site of holding ET and TTI were analyzed. The mean site was 3 SD 2.5 cm from the tip, yielding two sites for the study- 19 cm (Gr 1) and 24 cm (Gr 2). To detect a 20% difference in intubation time between groups, the confidence of 95%, and power 85%, we will need 298 patients: 180 per group after accounting for data loss.Discussion: This will be the first study to assess whether holding the tube at a particular site has any impact on the ease and time taken for intubation. This study's findings will provide the first scientific evidence for an appropriate place for holding the ET during LEI, which we feel will help trainees improve their LEI technique.Trial registration: CTRI/2019/09/021201, Clinical Trials Registry India. http://ctri.nic.in/Clinicaltrials/advsearch.php. Registered 12th September 2019,

scholarly journals Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

2019 ◽  
Vol 47 (6) ◽  
pp. 2740-2745
Author(s):  
Seung Youp Baek ◽  
Jin Hwan Kim ◽  
Goo Kim ◽  
Jin Ho Choi ◽  
Chang Young Jeong ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Left Lung ◽  
Lung Ventilation ◽  
Surgical Excision ◽  
One Lung Ventilation ◽  
Lower Lung ◽  
Endobronchial Blocker ◽  
Surgical Field ◽  
The Right

A 7-year-old child underwent surgical excision of a benign mesothelioma of the pleura near the right lower lung. Although insertion of a wire-reinforced endotracheal tube through the left main bronchus was attempted for one-lung ventilation to secure the surgical field of view, the attempt failed. Therefore, an endotracheal tube was inserted into the trachea, and an Arndt endobronchial blocker (Cook Medical, Bloomington, IN, USA) was placed in the right intermediate bronchus under bronchoscopic guidance to selectively block the right lower and middle lobes. The surgery was performed while ventilating the right upper lobe and left lung, and no specific intraoperative adverse events occurred.

scholarly journals PERBANDINGAN PEMBERIAN DEXAMETHASONE 10 MG INTRAVENA DAN LIDOCAINE SPRAY PADA TINGKAT KENYAMANAN PASCA INTUBASI ENDOTRACHEAL TUBE DI RSUD ARIFIN ACHMAD PROVINSI RIAU

2019 ◽  
Vol 19 (2) ◽  
Author(s):  
Dino Irawan ◽  
Nopian Hidayat
Keyword(s):  
General Anesthesia ◽  
Endotracheal Tube ◽  
General Hospital ◽  
Sore Throat ◽  
Endotracheal Intubation ◽  
Cuff Pressure ◽  
Controlled Trial ◽  
History Of ◽  
The Difference ◽  
Lidocaine Spray

Abstrak. Penelitian ini berjudul perbandingan tingkat kenyamanan pasca pembiusan umum dengan endotracheal tube antara pemberian dexametasone intravena dan lidocaine spray di RSUD Arifin Achmad Provinsi  Riau. Tingkat kenyamanan berupa nyeri tenggorok pada pasien yang menjalani pembiusan umum dengan intubasi endotrakeal dapat dipengaruhi oleh beberapa hal yaitu obat-obatan yang diberikan, teknik insersi, tekanan cuff dan manajemen setelah insersi.Nyeri tenggorok pada pasien yang menjalani anestesi umum dengan intubasi endotrakeal pada umumnya tidak berakibat fatal dan akan menghilang dalam 48-72 jam setelah operasi tetapi hal ini dapat menyebabkan gangguan yang cukup berarti bagi pasien, menambah lama dan biaya rawatan pasien di rumah sakit serta meninggalkan kesan buruk terhadap operasi. Penelitian ini menggunakan pendekatan randomized clinical controlled trial dengan rancangan eksperimental yang dilakukan pada 104 pasien yang menjalani anestesi umum dengan endotrakeal tube di RSUD Arifin Achmad Provinsi Riau pada bulan September-Oktober 2019. Pada hasil penelitian didapatkan bahwa pemberian dexametasone intravena sebelum tindakan intubasi endotrakeal lebih efektif dalam mencegah nyeri tenggorok pasca operasi dibandingkan lidocaine spray (19.2% untuk Dexametasone intravena dan 29.8% pada Lidocaine spray). Secara statistik, perbedaan kejadian nyeri tenggorok antara kelompok Dexametasone intravena dan Lidocaine spray adalah bermakna pada skoring 1 jam post operasi (p 0.05) dan tidak bermakna pada skoring 24 jam post operasi (p0.05). Insidensi nyeri tenggorok terbanyak berdasarkan usia adalah pada kelompok usia 46-55 tahun dan 55-65 tahun, berdasarkan jenis kelamin adalah lebih banyak pada perempuan dibandingkan laki-laki, dan lebih banyak pada pasien yang mempunyai riwayat merokok. Kata kunci: nyeri tenggorok, dexametasone intravena, lidocaine spray, RSUD Arifin Achmad Provinsi Riau Abstract. This study is about the comparison of the level of comfort after general anesthesia with an endotracheal tube between administration of intravenous dexametasone and lidocaine spray in Arifin Achmad General Hospital of Riau Province. The level of comfort in the form of sore throat in patients undergoing general anesthesia with endotracheal intubation can be influenced by several things such as administration of drugs, insertion techniques, cuff pressure and management after insertion. Sore throat in patients undergoing general anesthesia with endotracheal intubation is generally not fatal and will disappear within 48-72 hours after surgery but this can cause significant disruption to the patient, increase the length and cost of patient care in the hospital and leave bad impression from surgery. This study is a randomized clinical controlled trial with an experimental design conducted on 104 patients undergoing general anesthesia with endotracheal tube at Arifin Achmad General Hospital in Riau Province in September-October 2019. The study found that administration of intravenous dexametasone before endotracheal intubation is more effective in preventing postoperative sore throat compared to lidocaine spray (19.2% for intravenous Dexametasone and 29.8% in Lidocaine spray). Statistically, the difference in the incidence of sore throat between the intravenous Dexametasone group and Lidocaine spray was significant at 1 hour postoperative scoring (p 0.05) and not significant at 24 hour postoperative scoring (p 0.05). The highest incidence of sore throat by age is in the age group 46-55 years and 56-65 years, more frequent in women than men, and more frequent in patients who have a history of smoking. Keywords: sore throat, intravenous dexametasone, lidocaine spray, Arifin Achmad General Hospital Riau Province

scholarly journals Providing one-lung ventilation in posttracheostomic tracheal stenosis for thoracoscopic plastic of the right diaphragm dome

2021 ◽  
Vol 18 (5) ◽  
pp. 76-81
Author(s):  
D. G. Kabakov ◽  
A. Yu. Zaytsev ◽  
M. A. Vyzhigina ◽  
K. V. Dubrovin ◽  
G. A. Kazaryan ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Tracheal Stenosis ◽  
Main Bronchus ◽  
Prolonged Mechanical Ventilation ◽  
Nasotracheal Intubation ◽  
Lung Ventilation ◽  
High Frequency Ventilation ◽  
One Lung Ventilation ◽  
Grade 3 ◽  
The Right

The article is devoted to the consideration of a clinical case of providing artifcial one-lung ventilation for performing thoracoscopic plastic of the right dome of the diaphragm in a patient with grade 3 posttracheostomy cicatricial tracheal stenosis. The patient is presented after a new coronavirus infection COVID-19 from 2020, prolonged mechanical ventilation through a tracheostomy tube (74 days), the development of medium thoracic cicatricial tracheal stenosis of grade 3 (the lumen of the narrowest part of the trachea is 4 mm) after decannulation and the development of relaxation of the right dome of the diaphragm (according to CT data, the dome is located at the level of the IV intercostal space). The frst stage under conditions of combined general anesthesia and high-frequency ventilation of the lungs was performed to restore the lumen of the trachea by bougienage of the stenosis area with tubes of a rigid endoscope under the control of a fberoptic bronchoscope with further nasotracheal intubation with a thermoplastic single-lumen endotracheal tube with a diameter of 8.0 with a cuff. At the second stage, during thoracoscopic plastic of the right dome of the diaphragm, to provide artifcial one-lung ventilation, a bronchial blocker was used, introduced through the same endotracheal tube into the right main bronchus under the control of a fberoptic bronchoscope.

scholarly journals A Reinforced Endotracheal Tube Completely Severed by a Patient Bite and Lodged in the Right Main Bronchus

2017 ◽  
Vol 32 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Susie Yoon ◽  
Hyunjung Choo ◽  
Se Eun Kim ◽  
Heeyeon Kwon ◽  
Hannah Lee
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
The Right

scholarly journals The combination of computed tomography measurements and flexible video bronchoscope guidance for accurate placement of the right-sided double-lumen tube: a randomized controlled trial

2020 ◽  
Author(s):  
Yongheng Hou ◽  
Huayue Liu ◽  
Wencheng Shi ◽  
Hengjing Zhao ◽  
Ke Peng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Main Bronchus ◽  
Controlled Trial ◽  
Fiberoptic Bronchoscopy ◽  
Double Lumen Tube ◽  
Control Group ◽  
Trial Registry ◽  
Double Lumen ◽  
Lumen Tube ◽  
The Right

Abstract Background: Accurate placement of the right-sided double-lumen tube (RDLT) is still challenging. This study aims to explore the feasibility and accuracy of a modified intubation strategy by using a combination of computed tomography measurements and flexible video bronchoscope guidance.Methods: 108 adults requiring an RDLT for lung isolation were randomly allocated to 2 groups. Conventional fiberoptic bronchoscopy-guided technique was used in the control group. The following specifications applied to the modification group. Firstly, the length of the right main bronchus (RMB-L) and the anteroposterior diameter of RMB were measured in preoperative spiral computed tomography to predict the side and size of the tube; Then, a depth marker was made on RUSCH tube according to the difference between the RMB-L and the length of bronchia cuff (12 mm); Under the guidance of flexible video bronchoscope, the depth marker should be paralleled with the tracheal carina, and a characteristic white line on the tube should be paralleled with the secondary carina.Results: Compared with the control group, our modified strategy significantly increased the optimal plus acceptable position rate (76% vs. 98%, respectively; P < 0.039), decreased tube replacement rate (80% vs. 94%; P = 0.042), shortened the intubation time (101.4 ± 7.3 vs. 75.2 ± 8.1 seconds; P = 0.019), and had a lower incidence of transient hypoxemia (25% vs. 6%; P = 0.022), subglottic resistance (20% vs. 6%; P = 0.037), tracheobronchial injury (35% vs. 13; P = 0.037), and postoperative right upper lobe collapse (15% vs. 2%; P = 0.059).Conclusion: These data suggest the superiority of our modified technique compared to the conventional method for RDLT positioning.Trial registration: Chinese Clinical Trial Registry, ChiCTR1900021676, registered on 5 March 2019. URL of trial registry: http://www.chictr.org.cn/showprojen.aspx?proj=33189

A New and Safe Method to Control the Depth of Endotracheal Intubation in Neonates

PEDIATRICS ◽  
1974 ◽  
Vol 54 (4) ◽  
pp. 506-508
Author(s):  
Alexandra Loew ◽  
Donald W. Thibeault
Keyword(s):  
Endotracheal Intubation ◽  
Main Bronchus ◽  
Lower Lobe ◽  
Lung Field ◽  
Safe Method ◽  
Interstitial Emphysema ◽  
Breath Sounds ◽  
Present Technique ◽  
The Right

Endotracheal intubation in neonates is usually performed during emergency resuscitation. The most common and most serious complication of endotracheal intubation is placement of the tube in the right main bronchus followed by overventilation of the right lower lobe which is often associated with underventilation and atelectasis of the remainder of the lungs.1 If the inflation of the right lower lobe is excessive then alveolar rupture and interstitial emphysema may follow.2 The present technique of endotracheal intubation is to insert the tube into the trachea and then auscultate over both lung fields. If breath sounds are decreased over one lung field then the tube is slightly withdrawn.

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