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Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures

OBJECTIVES: Postintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tu...

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Autores principales: Sudhoff, Tobias H., Seidl, Rainer O., Estel, Barbara, Coordes, Annekatrin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Otorhinolaryngology-Head and Neck Surgery 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661260/
https://www.ncbi.nlm.nih.gov/pubmed/26622963
http://dx.doi.org/10.3342/ceo.2015.8.4.409
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author Sudhoff, Tobias H.
Seidl, Rainer O.
Estel, Barbara
Coordes, Annekatrin
author_facet Sudhoff, Tobias H.
Seidl, Rainer O.
Estel, Barbara
Coordes, Annekatrin
author_sort Sudhoff, Tobias H.
collection PubMed
description OBJECTIVES: Postintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tube sizes), and to explain the context, why small women are particularly susceptible to PTR. METHODS: Experimental study performed on 28 fresh human laryngotracheal specimens (16 males, 12 females) within 24 hours post autopsy. Artificial ventilation was simulated by using an underwater construction and a standard tracheal tube. Tube sizes were selected according to our previously published nomogram. Tracheal lesions were detected visually and tracheal diameters measured. The influence of body size, sex difference and appropriate tube size were investigated according to patient height. RESULTS: In all 28 cases, the typical tracheal lesion pattern was a longitudinal median rupture of the posterior trachea. Appropriate tube sizes according to body size caused PTR with significantly higher cuff pressure when compared with oversized tubes. An increased risk of PTR was found in shorter patients, when oversized tubes were used. Sex difference did not have any significant influence. CONCLUSION: This experimental model provides information about tracheal patterns in PTR for the first time. The model confirms by experiment the observations of case series in PTR patients, and therefore emphasizes the importance of correct tube size selection according to patient height. This minimizes the risk of PTR, especially in shorter patients, who have an increased risk of PTR when oversized tubes are used.
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spelling pubmed-46612602015-12-01 Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures Sudhoff, Tobias H. Seidl, Rainer O. Estel, Barbara Coordes, Annekatrin Clin Exp Otorhinolaryngol Original Article OBJECTIVES: Postintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tube sizes), and to explain the context, why small women are particularly susceptible to PTR. METHODS: Experimental study performed on 28 fresh human laryngotracheal specimens (16 males, 12 females) within 24 hours post autopsy. Artificial ventilation was simulated by using an underwater construction and a standard tracheal tube. Tube sizes were selected according to our previously published nomogram. Tracheal lesions were detected visually and tracheal diameters measured. The influence of body size, sex difference and appropriate tube size were investigated according to patient height. RESULTS: In all 28 cases, the typical tracheal lesion pattern was a longitudinal median rupture of the posterior trachea. Appropriate tube sizes according to body size caused PTR with significantly higher cuff pressure when compared with oversized tubes. An increased risk of PTR was found in shorter patients, when oversized tubes were used. Sex difference did not have any significant influence. CONCLUSION: This experimental model provides information about tracheal patterns in PTR for the first time. The model confirms by experiment the observations of case series in PTR patients, and therefore emphasizes the importance of correct tube size selection according to patient height. This minimizes the risk of PTR, especially in shorter patients, who have an increased risk of PTR when oversized tubes are used. Korean Society of Otorhinolaryngology-Head and Neck Surgery 2015-12 2015-11-10 /pmc/articles/PMC4661260/ /pubmed/26622963 http://dx.doi.org/10.3342/ceo.2015.8.4.409 Text en Copyright © 2015 by Korean Society of Otorhinolaryngology-Head and Neck Surgery. http://creativecommons.org/licenses/by-nc/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Sudhoff, Tobias H.
Seidl, Rainer O.
Estel, Barbara
Coordes, Annekatrin
Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures
title Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures
title_full Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures
title_fullStr Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures
title_full_unstemmed Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures
title_short Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures
title_sort association of oversized tracheal tubes and cuff overinsufflation with postintubation tracheal ruptures
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661260/
https://www.ncbi.nlm.nih.gov/pubmed/26622963
http://dx.doi.org/10.3342/ceo.2015.8.4.409
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