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The Occurrence and Risk Factors of Inappropriately Deep Tip Position of Microcuff Pediatric Endotracheal Tube During PICU Stay: A Retrospective Cohort Pilot Study
- Source :
- Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 20(11)
- Publication Year :
- 2019
-
Abstract
- OBJECTIVES Cuffed endotracheal tubes are being used increasingly for pediatric patients on mechanical ventilation. Appropriate placement of the tube tip for Microcuff (Kimberley-Clark, Roswell, GA) pediatric endotracheal tube is guided by the intubation depth mark on the device. However, inappropriately deep tip position is sometimes observed during PICU stay. The purpose of this study was to assess the occurrence and risk factors of inappropriately deep tip position of Microcuff pediatric endotracheal tube during PICU stay. DESIGN A retrospective cohort study. SETTING The PICU at the National Center for Child Health and Development, one of the largest tertiary pediatric hospitals in Japan. PATIENTS All patients on mechanical ventilation with Microcuff pediatric endotracheal tube admitted between February 1, 2015, and July 31, 2016, were enrolled. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the occurrence of inappropriately deep tip position, defined as a position of the tube tip less than 5 mm above the carina on a chest radiograph. There were 179 cases (157 patients) requiring mechanical ventilation with Microcuff pediatric endotracheal tube during the study period. An inappropriately deep tip position was found in 42 cases (23.5%), including bronchial intubation in 13 cases (7.3%). In multivariate analysis, height in cm (odds ratio, 0.93; p < 0.001), history of abdominal disease or previous abdominal surgery (odds ratio, 4.38; p = 0.004), and oversized endotracheal tube (odds ratio, 2.93; p = 0.042) were found to be independent risk factors. CONCLUSIONS The occurrence of inappropriately deep tip position of Microcuff pediatric endotracheal tube during PICU stay was 23.5%. The possibility of an inappropriately deep tip position should be considered whenever patients with the above risk factors, a history of abdominal disease or previous abdominal surgery, and small children are treated or when oversized endotracheal tubes are used.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Pilot Projects
030204 cardiovascular system & hematology
Critical Care and Intensive Care Medicine
Intensive Care Units, Pediatric
03 medical and health sciences
0302 clinical medicine
Risk Factors
medicine
Intubation, Intratracheal
Intubation
Humans
Tip position
Endotracheal tube
Retrospective Studies
Mechanical ventilation
medicine.diagnostic_test
business.industry
Infant
030208 emergency & critical care medicine
Retrospective cohort study
Odds ratio
Respiration, Artificial
Surgery
Case-Control Studies
Pediatrics, Perinatology and Child Health
Female
Chest radiograph
business
Abdominal surgery
Subjects
Details
- ISSN :
- 15297535
- Volume :
- 20
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
- Accession number :
- edsair.doi.dedup.....e4d7f12f7a48aeccd9550d6b0843d2f6