title: Tracheal Tube Position Shift During Infant Resuscitation by Chest Compression: A Simulation Comparison by Fixation Method and With or Without Cuff.
abstract: BACKGROUND
  Tracheal tube placement during infant resuscitation is essential for definite airway protection. Accidental extubation due to tracheal tube displacement is a rare event, but it results in severe complications, especially in infants.
  
  
  OBJECTIVE
  The present study evaluated how infant tracheal tube displacement is affected by tape vs. tube holder fixation using a manikin.
  
  
  METHODS
  A tracheal tube with internal diameter of 3.5 mm was placed 10 cm from the gum ridge in an advanced life support (ALS) Baby(®) simulator (Laerdal, Stavanger, Norway). In the first trial, cuff pressure was set at 15, 20, and 25 cmH2O and trials were performed at each setting with no fixation, Durapore(®) (3M, St Paul, MN) tape fixation, Multipore(®) (3M) tape fixation, and Thomas(®) Tube Holder (Laerdal) fixation. After 5 min of chest compression, the tracheal tube shift was measured. In the second trial, we compared the tube shift by chest compression with or without cuff in the same way.
  
  
  RESULTS
  Relative to no fixation, tracheal tube shift was significantly less in the Durapore, Multipore, and tube holder groups (p < 0.05) at all cuff settings. Of the three fixation methods, the tube holder showed significantly less shift (p < 0.05) relative to tape, regardless of the initial cuff pressure. The positional shift after chest compressions was significantly larger in the trials with cuff than in those without cuff in Durapore or Multipore fixation (p < 0.05), but did not in tube holder fixation.
  
  
  CONCLUSIONS
  There is less tracheal tube displacement with tube holder fixation than with tape during continuous infant chest compression simulation. The tube cuff can contribute to the positional shift of the tube during infant chest compression.
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ueno
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Komasawa
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Majima
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Mihara
authors.affiliation: Department of Anesthesiology, Osaka Medical College, Osaka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects*; D004867:Equipment Design; D006336:Heart Massage; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008348:Manikins
keywords: chest compression; infant; position shift; simulation; tracheal tube; tube fixation