Utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubation
Background and Aims: Optimal endotracheal tube (ETT) placement in patients with short tracheas by the existing techniques is challenging because of the fixed intratracheal ETT length of insertion. However, in the surface landmark technique (SLT), the individual’s tracheal length (distance between mi...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Journal of Anaesthesiology Clinical Pharmacology |
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| Online Access: | https://journals.lww.com/10.4103/joacp.joacp_363_23 |
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| author | Amit K. Mittal Anil K. Patel Jitendra Dubey Seema Shukla Nikhil Bhasin Manoj Bhardwaj |
| author_facet | Amit K. Mittal Anil K. Patel Jitendra Dubey Seema Shukla Nikhil Bhasin Manoj Bhardwaj |
| author_sort | Amit K. Mittal |
| collection | DOAJ |
| description | Background and Aims:
Optimal endotracheal tube (ETT) placement in patients with short tracheas by the existing techniques is challenging because of the fixed intratracheal ETT length of insertion. However, in the surface landmark technique (SLT), the individual’s tracheal length (distance between mid-thyroid and manubrium–sternum) was estimated and 3 cm was deducted from it to obtain the desired intratracheal ETT length of insertion. Being a new technique, its reliability in providing optimal placement is yet to be evaluated. Hence, to assess the utility and reliability of SLT in achieving optimal placement, this study was planned.
Material and Methods:
In this prospective study, 406 participants were equally randomized between SLT and intubation guide mark (IGM) groups for ETT placement. In both groups, ETT tip–carina distance (DTC) was measured to assess optimal placements. The placements were compared by paired t-test. The receiver operating characteristic (ROC) curve analysis was used to assess optimal ETT placement between techniques.
Results:
The mean DTC in the SLT (3.52 ± 0.68 cm) group was significantly higher than in the IGM (2.23 ± 1.01 cm) group, with P < 0.0001. Consequently, optimal placements were significantly higher in the SLT group (190 [95%]) compared to the IGM (121 [60.5%]) group (P < 0.0001). On ROC, at a cut-off value for DTC of 1.5 cm, the observed area under the curve to assess optimal ETT placements was significantly better in SLT (0.997, 95% confidence interval [CI] 0.997–1.000) compared to IGM (0.968, 95% CI 0.933–0.988), with P < 0.0001.
Conclusion:
Based on the measurement of an individual’s tracheal length, SLT is a reliable and useful technique to achieve optimal tube placement. |
| format | Article |
| id | doaj-art-c92e3a2e872a4e36b4e8b48308d0a63b |
| institution | OA Journals |
| issn | 2231-2730 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj-art-c92e3a2e872a4e36b4e8b48308d0a63b2025-08-20T02:13:41ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology2231-27302025-01-0141112613210.4103/joacp.joacp_363_23Utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubationAmit K. MittalAnil K. PatelJitendra DubeySeema ShuklaNikhil BhasinManoj BhardwajBackground and Aims: Optimal endotracheal tube (ETT) placement in patients with short tracheas by the existing techniques is challenging because of the fixed intratracheal ETT length of insertion. However, in the surface landmark technique (SLT), the individual’s tracheal length (distance between mid-thyroid and manubrium–sternum) was estimated and 3 cm was deducted from it to obtain the desired intratracheal ETT length of insertion. Being a new technique, its reliability in providing optimal placement is yet to be evaluated. Hence, to assess the utility and reliability of SLT in achieving optimal placement, this study was planned. Material and Methods: In this prospective study, 406 participants were equally randomized between SLT and intubation guide mark (IGM) groups for ETT placement. In both groups, ETT tip–carina distance (DTC) was measured to assess optimal placements. The placements were compared by paired t-test. The receiver operating characteristic (ROC) curve analysis was used to assess optimal ETT placement between techniques. Results: The mean DTC in the SLT (3.52 ± 0.68 cm) group was significantly higher than in the IGM (2.23 ± 1.01 cm) group, with P < 0.0001. Consequently, optimal placements were significantly higher in the SLT group (190 [95%]) compared to the IGM (121 [60.5%]) group (P < 0.0001). On ROC, at a cut-off value for DTC of 1.5 cm, the observed area under the curve to assess optimal ETT placements was significantly better in SLT (0.997, 95% confidence interval [CI] 0.997–1.000) compared to IGM (0.968, 95% CI 0.933–0.988), with P < 0.0001. Conclusion: Based on the measurement of an individual’s tracheal length, SLT is a reliable and useful technique to achieve optimal tube placement.https://journals.lww.com/10.4103/joacp.joacp_363_23endotracheal intubationendotracheal tube tip-to-carina distanceintubation guide markoptimal tube placementstracheal surface landmarks |
| spellingShingle | Amit K. Mittal Anil K. Patel Jitendra Dubey Seema Shukla Nikhil Bhasin Manoj Bhardwaj Utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubation Journal of Anaesthesiology Clinical Pharmacology endotracheal intubation endotracheal tube tip-to-carina distance intubation guide mark optimal tube placements tracheal surface landmarks |
| title | Utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubation |
| title_full | Utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubation |
| title_fullStr | Utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubation |
| title_full_unstemmed | Utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubation |
| title_short | Utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubation |
| title_sort | utility of surface landmark technique in providing optimal intratracheal endotracheal tube placement during orotracheal intubation |
| topic | endotracheal intubation endotracheal tube tip-to-carina distance intubation guide mark optimal tube placements tracheal surface landmarks |
| url | https://journals.lww.com/10.4103/joacp.joacp_363_23 |
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