Correct Endotracheal Tube Placement Using Topographical Landmarks

Rajiv Gandhi Cancer Institute & Research Center, India

Status: Not yet enrolling

Conditions: Intubation, Intratracheal; Anatomic Landmarks

Treatments: Device: Intubation guide mark technique of endotracheal tube placement; Device: Topographical landmark technique of endotracheal tube placement

Study type: Interventional

Funder types: Other

Identifiers

NCT05439109

RES/SCM/35/2019/68

Details and patient eligibility

About

An optimal endotracheal tube depth is ideally required for preventing the complications associated with mal-positioning of the endotracheal tube. The topographical technique of tube placement considering the individual's morphometric dimensions could help to provide optimal tube placement. hence, to evaluate the efficacy of the topographical technique in providing the optimal tube placement this study will be conducted.

Full description

The trachea is a dynamic organ and its length varies by various static and dynamic factors leading to changing the tracheal length and variable endotracheal tube tip to carina (Ti-Ca) distance. Hence, upholding optimal Ti-Ca distance during changing tracheal length is of utmost importance to prevent complications associated with endotracheal tube (ETT) mal-positioning. When the length of ETT, which is to be inserted inside the trachea, is calculated as per an individual's tracheal morphometric dimensions, the appropriate depth of placement could be achieved and tube malpositioning can be prevented. In the topographical landmark technique, an individual tracheal length is estimated by measuring the various distance from mid-thyroid level (corresponds to vocal cords) to manubriosternal joint (corresponds to carina) in the sagittal plane. After estimating the tracheal length, tip to carina distance of 3cm was deducted from the estimated length of the trachea to provide the distance of the endotracheal tube to be kept beyond the vocal cords. Hence, the investigators planned this study to find the "utility and reliability" of the topographical landmark technique compared to the conventional intubation guide mark technique in providing the appropriate depth of endotracheal tube placement.

Enrollment: 400 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• • Age group of 18-75 years

  • ASA physical status I-III patients
  • Oral intubation for general anesthesia

Exclusion criteria

• • Patient with upper airway fibrosis

  • Tracheal stenosis or tracheal surgeries
  • Previous head and neck surgeries
  • Contracture neck or irradiated neck
  • Large neck swelling distorting or deviating the trachea
  • Laryngeal or tracheal tumor
  • Intubations requiring flexo-metallic tubes
  • Patient refusal

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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400 participants in 2 patient groups

Topographical landmark technique

Experimental group

Description:

Surface anatomic landmarks of an individual's trachea will be measured from the mid-thyroid level (corresponds to vocal cords) to manubriosternal joint (corresponds to carina) in the sagittal plane to estimate tracheal length. Three centimeters will be deducted from the estimated tracheal length to provide the length of the endotracheal tube from the tube tip to be inserted inside the trachea.

Treatment:

Device: Topographical landmark technique of endotracheal tube placement

Intubation guide mark technique

Active Comparator group

Description:

Already established and commonly practiced technique, in this technique, the guide mark present above the proximal end of the endotracheal tube cuff will be placed just beyond the vocal cords.

Treatment:

Device: Intubation guide mark technique of endotracheal tube placement