title: Association of Oversized Tracheal Tubes and Cuff Overinsufflation With Postintubation Tracheal Ruptures.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology, Intensive Care Medicine and Pain Therapy, Unfallkrankenhaus Berlin, Charité Medical School, Berlin.
authors.forename: Tobias H
authors.initials: TH
authors.lastname: Sudhoff
authors.affiliation: Department of Otolaryngology, Intensive Care Medicine and Pain Therapy, Unfallkrankenhaus Berlin, Charité Medical School, Berlin.
authors.forename: Rainer O
authors.initials: RO
authors.lastname: Seidl
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Unfallkrankenhaus Berlin, Charité Medical School, Berlin.
authors.forename: Barbara
authors.initials: B
authors.lastname: Estel
authors.affiliation: Department of Otolaryngology, Intensive Care Medicine and Pain Therapy, Unfallkrankenhaus Berlin, Charité Medical School, Berlin. ; Department of Otorhinolaryngology-Head and Neck Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Annekatrin
authors.initials: A
authors.lastname: Coordes
keywords: Pressure; Respiration, Artificial; Rupture; Trachea; Ventilation