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. 2024 Jan 8;16(1):e51895.
doi: 10.7759/cureus.51895. eCollection 2024 Jan.

Appropriate Endotracheal Tube Position for Percutaneous Dilatational Tracheostomy: A Single-Center Observational Study

Takahiro Michishita  1 , Naoya Suzuki  1 , Takeru Abe  2 , Kento Nakajima  2 , Masayasu Gakumazawa  1 , Tomoki Doi  1 , Ichiro Takeuchi  2
Affiliations

Appropriate Endotracheal Tube Position for Percutaneous Dilatational Tracheostomy: A Single-Center Observational Study

Takahiro Michishita et al. Cureus. .

Abstract

Aim This study aimed to investigate the appropriate endotracheal tube (ETT) position during percutaneous dilatational tracheostomy (PDT). Methods This single-center observational study included hospitalized patients who underwent surgical tracheostomy (ST) between August 2021 and October 2022. During ST, the trachea was opened, and the ETT was pulled out visually. It stopped when the ETT was no longer visible, and the tracheostomy tube was placed in the trachea. The ETT position was measured by considering the ETT position during ST to be the appropriate position during PDT. The correlation between the measured ETT position and patient characteristics was evaluated. A prediction equation for the ETT position was derived from the derivation group, and validation of the prediction equation was evaluated by the validation group. Results Forty-six and 15 patients were in the derivation and validation groups, respectively. Weight, duration of intubation, and in-hospital mortality were significantly different between the two groups. The measured ETT position correlated with body height (r=0.60, p<0.001) and sex (r=0.45, p=0.002), while the ETT position before ST showed a weak correlation (r=0.34, p=0.020). The predicted and measured values in the validation group correlated with each other (r=0.58, p=0.024). Conclusion The appropriate ETT position for PDT correlates with body height, and the equation "body height×0.112-0.323 cm" was derived. This predictive equation may be useful as a guide for ETT positioning during PDT puncture.

Keywords: endotracheal tube; endotracheal tube position; percutaneous dilatational tracheostomy; prediction equation; surgical tracheostomy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Method of ETT position measurement during ST
A: The subcutaneous skin is peeled off and the trachea is opened. B: The ETT is pulled out such that the tip of the tube is no longer visible. From the Ciaglia Blue Rhino IFU images, Cook Medical. Copyright © Cook Medical. Reprinted and partially modified with permission from Cook Medical. ETT: endotracheal tube; ST: surgical tracheostomy
Figure 2
Figure 2. Correlation between patient characteristics and measured ETT position in the derivation group
ETT: endotracheal tube; ST: surgical tracheostomy
Figure 3
Figure 3. Scatter plots of the predicted and measured values in the validation group
ETT: endotracheal tube
Figure 4
Figure 4. ETT position at puncture in PDT
A: Appropriate ETT position. B: Deep ETT position. C: Shallow ETT position. From the Ciaglia Blue Rhino IFU images, Cook Medical. Copyright © Cook Medical. Reprinted and partially modified with permission from Cook Medical. ETT: endotracheal tube; PDT: percutaneous dilatational tracheostomy
See this image and copyright information in PMC

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