Head rotation, flexion, and extension alter endotracheal tube position in adults and children

Abstract

Purpose: The purpose of this study was to evaluate the effect of head rotation in adults and children on endotracheal tube (ETT) position and to confirm previous results regarding the influence of head flexion and extension on ETT position.

Methods: After inducing anesthesia in 24 young adults and 22 children (aged 1-9 yr), ETTs were secured on the right corner of each of their mouths. Using a fiberoptic bronchoscope, the distance from the carina to the tip of the ETT was measured with each patient's head and neck placed in a neutral position, flexed, extended, rotated to the right, and rotated to the left.

Results: In all patients, flexing the head resulted in the ETT moving towards the carina, and extension resulted in the tube being displaced in the opposite direction. In adults, head rotation to the right resulted in withdrawal of the ETT in all but one patient; displacement was 0.8 +/- 0.5 cm (mean +/- SD) (P < 0.001). Head rotation to the left resulted in the endotracheal tube being displaced in an unpredictable direction by 0.1 +/- 0.6 cm. In children, head rotation to the right resulted in withdrawal of the ETT in all patients; displacement was 1.1 +/- 0.6 cm (P < 0.001). Head rotation to the left also resulted in partial withdrawal in all patients; displacement measured 0.6 +/- 0.4 cm (P < 0.001).

Conclusions: In adult patients under general anesthesia, head rotation towards the side of ETT fixation resulted in partial withdrawal of the tube tip away from the carina, whereas head rotation to the opposite side displaced the tube in an unpredictable manner. In children, head rotation to either side resulted in withdrawal of the ETT away from the carina.