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Poor performance of the pediatric airway exchange catheter in adults with cervical spine immobilization

Performances insatisfaisantes d’un échangeur de sonde pédiatrique chez des adultes présentant une immobilisation de la colonne cervicale

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Abstract

Purpose: Use of a pediatric airway exchange catheter (PAEC) has been advocated as a potentially useful adjunct for difficult extubations. We evaluated the laryngeal passing ability of a tracheal tube over a PAEC and compared its success rate between adult patients in the sniffing position and adult patients with simulated cervical spine immobilization created using a manual in-line axial stabilization (MIAS) technique.

Methods: A total of 100 adult patients were randomized into two groups of equal size with respect to position during the simulated reintubation trial: the MIAS position (Group M) and the sniffing position (Group S). After induction of anesthesia, an 11-F PAEC was placed in the trachea under direct laryngoscopic view, and a wire-reinforced tube (with its bevel facing to the left) was gently railroaded over the PAEC and into the trachea. If insertion was impeded, a second attempt was made after rotating the tube 90° counterclockwise. If this also failed, one additional attempt was made using external laryngeal pressure before changing to conventional laryngoscopic intubation.

Results: After the second attempt, the cumulative success rates in Groups M and S were 41.3% and 72.3%, respectively (P=0.003). After three attempts, the overall success rate was significantly lower in Group M (52.2%) than in Group S (76.6%) (P=0.018).

Conclusion: Owing to the high failure rate of PAEC-guided intubation in patients with simulated cervical spine immobilization, use of a PAEC is not recommended for maintaining continuous airway access after extubation in adult patients with cervical immobility or instability.

Résumé

Objectif: L’utilisation d’un échangeur de sonde pédiatrique (PAEC) a été recommandée en tant que complément potentiellement utile dans le cas d’extubations difficiles. Nous avons évalué la capacité de passage au niveau laryngé d’une sonde trachéale par rapport à une PAEC et comparé son taux de réussite entre des patients adultes en position de reniflement et des patients adultes présentant une immobilisation simulée de la colonne cervicale, créée à l’aide d’une technique de stabilisation manuelle axiale en ligne (MIAS).

Méthode: Au total, 100 patients adultes ont été randomisés en deux groupes de taille égale selon leur position pendant l’essai de réintubation simulée : la position MIAS (groupe M) et la position de reniflement (groupe S). Après l’induction de l’anesthésie, une PAEC 11-F a été placé dans la trachée sous vision laryngoscopique directe, et une sonde à armature métallique (le biseau orienté vers la gauche) a été doucement acheminée au-dessus du PAEC et dans la trachée. Si l’insertion était entravée, une deuxième tentative était effectuée après avoir tourné la sonde de 90° dans le sens inverse des aiguilles d’une montre. Si cette deuxième tentative échouait, une tentative supplémentaire était effectuée à l’aide de pression laryngée externe avant de passer à une intubation laryngoscopique traditionnelle.

Résultats: Après la deuxième tentative, les taux de réussite cumulatifs dans les groupes M et S étaient de 41,3 % et 72,3 %, respectivement (P=0,003). Après trois tentatives, le taux de réussite global était significativement plus bas dans le groupe M (52,2 %) que dans le groupe S (76,6 %) (P=0,018).

Conclusion: En raison du taux d’échec élevé d’une intubation guidée par le PAEC chez des patients présentant une immobilisation simulée de la colonne cervicale, l’utilisation du PAEC n’est pas recommandée si l’on doit maintenir un accès continu aux voies respiratoires après extubation chez les patients au rachis cervical immobilisé ou instable.

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Correspondence to Duk-Kyung Kim md.

Additional information

The authors received no financial support from any pharmaceutical or medical device companies.

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Kim, D., Kim, H., Lee, K. et al. Poor performance of the pediatric airway exchange catheter in adults with cervical spine immobilization. Can J Anesth 55, 748–753 (2008). https://doi.org/10.1007/BF03016347

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Keywords

  • Cervical Spine
  • Tracheal Tube
  • Cervical Spine Injury
  • Assistant Nurse
  • Tracheal Extubation