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Stylet Bend Angles and Tracheal Tube Passage Using a Straight-to-cuff Shape

2006; Wiley; Volume: 13; Issue: 12 Linguagem: Inglês

10.1111/j.1553-2712.2006.tb00286.x

1553-2712

Richard M. Levitan, James T. Pisaturo, William C. Kinkle, Kenneth H. Butler, Worth W. Everett,

Obstructive Sleep Apnea Research

Academic Emergency MedicineVolume 13, Issue 12 p. 1255-1258 Free Access Stylet Bend Angles and Tracheal Tube Passage Using a Straight-to-cuff Shape Richard M. Levitan MD, Corresponding Author Richard M. Levitan MD Albert Einstein Medical Center, Philadelphia, PA*Email: airwaycam@gmail.comSearch for more papers by this authorJames T. Pisaturo EMT-P, James T. Pisaturo EMT-P Hospital of the University of Pennsylvania, Philadelphia, PASearch for more papers by this authorWilliam C. Kinkle RN, William C. Kinkle RN Hospital of the University of Pennsylvania, Philadelphia, PASearch for more papers by this authorKenneth Butler DO, Kenneth Butler DO University of Maryland Medical System (KB), Baltimore, MDSearch for more papers by this authorWorth W. Everett MD, Worth W. Everett MD Hospital of the University of Pennsylvania, Philadelphia, PASearch for more papers by this author Richard M. Levitan MD, Corresponding Author Richard M. Levitan MD Albert Einstein Medical Center, Philadelphia, PA*Email: airwaycam@gmail.comSearch for more papers by this authorJames T. Pisaturo EMT-P, James T. Pisaturo EMT-P Hospital of the University of Pennsylvania, Philadelphia, PASearch for more papers by this authorWilliam C. Kinkle RN, William C. Kinkle RN Hospital of the University of Pennsylvania, Philadelphia, PASearch for more papers by this authorKenneth Butler DO, Kenneth Butler DO University of Maryland Medical System (KB), Baltimore, MDSearch for more papers by this authorWorth W. Everett MD, Worth W. Everett MD Hospital of the University of Pennsylvania, Philadelphia, PASearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1197/j.aem.2006.06.058Citations: 33AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Objectives Malleable stylets improve maneuverability and control during tube insertion, but after passage through the vocal cords the stiffened tracheal tube may impinge on the tracheal rings, preventing passage. The goal of this study was to assess insertion difficulty with styletted tubes of different bend angles. Methods Tube passage was assessed with four different bend angles (25°, 35°, 45°, and 60°) using straight-to-cuff–shaped tubes. In two separate airway procedure classes, 16 operators in each class (32 total) placed randomly ordered styletted tubes of the different angles into eight cadavers (16 total). Operators subjectively graded the ease of tube passage as no resistance, some resistance, or impossible to advance. Results No resistance was reported in 69.1% (177/256) at 25°, in 63.7% (163/256) at 35°, in 39.4% (101/256) at 45°, and in 8.9% (22/256) at 60°. Tube passage was impossible in 2.3% of insertions (6/256) at 25°, in 3.5% (9/256) at 35°, in 11.3% (29/256) at 45°, and in 53.9% (138/256) at 60°. The odds ratios of impossible tube passage for 35°, 45°, and 60° vs. 25° were 1.52 (95% confidence interval [CI] = 0.55 to 4.16), 5.32 (95% CI = 2.22 to 12.71), and 48.72 (95% CI = 21.35 to 111.03), respectively. Conclusions Bend angles beyond 35° with straight-to-cuff styletted tracheal tubes increase the risk of difficult and impossible tube passage into the trachea. The authors did not compare different stylet stopping points, stylets of different stiffness, or tracheal tubes with different tip designs, all variables that can affect tube passage. References Benumof JL. Conventional (laryngoscopic) orotracheal and nasotracheal intubation (single lumen tube) In: JL Benumnof editor. Airway Management: Principles and Practice. St Louis , MO : Mosby-Yearbook, 1996. pp. 270. Roberts JR, Hedges JR. Clinical procedures in emergency medicine3rd ed.. Philadelphia : PA, 1998 p 18. Danzl DF. Advanced airway support In: JE Tintinalli, E Ruiz, RL Krome editors. 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Citing Literature Volume13, Issue12December 2006Pages 1255-1258 ReferencesRelatedInformation