title: Retrospective analysis of vocal cord-to-suprasternal notch distance: Implications for preventing endotracheal tube cuff-induced vocal cord injury.
abstract: Endotracheal tube (ETT) positioning using the cuff ballottement test, which confirms that the inflated cuff is positioned at the suprasternal notch with squeezing or inflating a pilot balloon, has been reported to be a simple and reliable method of preventing endobronchial intubation. However, in patients with a short vocal cord-to-suprasternal notch, ETT placement using the cuff ballottement test can cause vocal cord injury. In the present study, we assessed the distance from a point 15 mm below the vocal cord to the suprasternal notch (VSD-15), the safe position for ETT cuff placement above the suprasternal notch, and investigated variables for predicting VSD-15.We retrospectively examined neck computed tomography in 427 adult patients and measured VSD-15 and the distance from the thyroid notch to the suprasternal notch (TSD). Patient height, weight, sex, and age were also recorded.In total, 47 patients (11.0%) showed a VSD-15 shorter than 45 mm. VSD-15 significantly correlated with TSD (r = 0.778, P < 0.001) and height (r = 0.312, P < 0.001), and inversely correlated with age (r = -0.321, P < 0.001). In multiple linear regression models, a formula was obtained for VSD-15 (VSD-15 [mm] = -6.220 + 0.744 × TSD [mm] + 0.092 × height [cm] - 0.065 × age [years], R = 0.621).The cuff ballottement test should be used cautiously in patients with a predicted short VSD-15. VSD-15 can be predicted from TSD, height, and age.
authors.affiliation: Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul Department of Anesthesiology and Pain Medicine, Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seong-nam Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea.
authors.forename: Hyerim
authors.initials: H
authors.lastname: Kim
authors.forename: Jee-Eun
authors.initials: JE
authors.lastname: Chang
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Ryu
authors.forename: Haesun
authors.initials: H
authors.lastname: Jung
authors.forename: Seong-Won
authors.initials: SW
authors.lastname: Min
authors.forename: Jung-Man
authors.initials: JM
authors.lastname: Lee
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001837:Body Weights and Measures; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D014827:Vocal Cords / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000293:injuries