Alteration of endotracheal tube position Flexion and extension of the neck
Alteration of endotracheal tube position Flexion and extension of the neck
复制标题
改变气管插管位置 颈部屈曲和伸展
作者：
P. A. Conrardy;L. Goodman;F. Lainge;M. M. Singer
气管插管错位是治疗失败患者的常见并发症。怀疑头部的运动可能改变插管的位置并导致错位。研究了20例使用8.0 mm气管内插管（5例经口，15例经鼻）的呼吸衰竭成人患者。20例患者中有10例袖带放气。患者处于半直立坐姿，标准化便携式前后胸部X线片在颈部屈曲、中立和高血压状态下拍摄，其中5例患者在头部右侧旋转后拍摄。从每个X线片测量气管插管尖端相对于隆突的移动，无论插管路径或套囊充气状态如何，气管插管移动的距离相似。因此，将所有组合并进行分析。从中立位屈曲时，插管平均向隆突移动1.9 cm，伸展时，插管平均离开隆突1.9 cm，头部侧向旋转时，插管平均离开隆突0.7 cm。为了尽量减少这种错位可能造成的伤害，我们建议将气管插管的头端置于气管的中间三分之一处，颈部处于中立位置。最后，头部位置的知识是至关重要的，以正确的放射线解释气管插管的位置。
Malposition of the endotracheal tube is a frequent complication in patients being treated for ventilatory failure. It was suspected that motion of the head might alter the position of the tube and result in malposition. Twenty adult patients with ventilatory failure, in tubated with an 8.0-mm endotracheal tube (5 oral and 15 nasal) were studied. The cuff was deflated in 10 of the 20 patients. With the patient in a semierect sitting position, standardized portable anterior-posterior chest roentgenograms were obtained with the neck in flexion, neutral, and hypertension and in 5 of the patients after right lateral head rotation. Movement of the endotracheal tube tip relative to the carina was measured from each roentgenogram.The endotracheal tube moved a similar distance regardless of the route of intubation or the inflation status of the cuff. Therefore, all groups were combined for analysis. The tube moved an average of 1.9 cm toward the carina with flexion from a neutral position, 1.9 cm away from the carina with extension, and 0.7 cm away with lateral head rotation.Malposition of the endotracheal tube may result from changes in head position. To minimize the possible injurious effects of that malposition, we recommend that the tip of the endotracheal tube be placed in the middle third of the trachea with the neck in a neutral position. Finally, knowledge of the head position is crucial to the proper radiographic interpretation of endotracheal tube position.