Preventing cuff rupture during tracheostomy: importance of endotracheal tube positioning.
OBJECTIVE
The objective of our study is to describe the technique of distal endotracheal tube (ETT) positioning for avoiding cuff rupture and validate the technique in a virtual tracheostomy model.


METHODS
A prospective nonrandomized case series of 129 patients who had undergone tracheostomy using the senior author's technique were evaluated. Primary outcome was ETT cuff rupture. One hundred normal patient computed tomography (CT) scans were used to generate a virtual tracheostomy model, and the probability of cuff rupture, among other values, was obtained.


RESULTS
One hundred twenty-three of 129 patients underwent tracheostomy without cuff rupture when the distal tip of the ETT was placed just proximal to the carina. After analysis of 100 3-dimensional CT scans, the average distance from the tracheotomy to the superior aspect of the cuff was 54.6 mm in men and 39.87 mm in women when a 6.5-size ETT was used, and 44.8 mm in men and 30.07 mm in women when a 7.5-size ETT was used. Virtual tracheotomy between the second and third tracheal rings resulted in no probability of inadvertent ETT cuff rupture.


CONCLUSIONS
Distal ETT positioning during tracheostomy should be considered for avoiding inadvertent ETT cuff rupture.
Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA.
Amit
A
Sood
Department of Diagnostic Radiology, George Washington University, Washington, DC, USA.
M Reza
MR
Taheri
Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC, USA ajoshi@mfa.gwu.edu.
Arjun S
AS
Joshi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D020680:Bronchoscopes; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D015203:Reproducibility of Results; D014132:Trachea / Q000293:injuries; D014139:Tracheostomy / Q000295:instrumentation / Q000379:methods*
ETT; cuff rupture; endotracheal tube; endotracheal tube position; quality improvement; resident training; tracheostomy; tracheostomy complications