Resuscitation 88 (2015) e7
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Confirmation of the depth of the endotracheal tube: Where should the cuff be?夽 Sir, In a prospective feasibility study, Tessaro et al. concluded that sonographic visualization of a saline-inflated ETT cuff at the suprasternal notch, which was named tracheal rapid ultrasound saline test (T.R.U.S.T.), is an accurate and rapid method for confirming correct endotracheal tube (ETT) insertion depth in children.1 It was a very novel idea to confirm the depth of the endotracheal tube in children. I am so excited to read it and I have two questions about the method. The first question was about the proper depth of the cuff. As the author described, they withdrew the ETT until the appearance of the saline-inflated cuff at the level of the sternal notch, and the mean ETT tip position was 2.7 cm above the carina. Some studies also demonstrated that put the cuff at the sternal notch could keep the ETT at the proper depth.2,3 However, the length of the cuff of the endotracheal tube ranged from 1.5 to 3 cm, none of the study demonstrated how long we should keep the cuff above the sternal notch. Part of the cuff or the entire cuff? Is there a standard? The second problem was the tracheal mucosal lesion. Although the pressure exerted by the cuff on the mucosa may exceed capillary perfusion pressure, it may not lead to mucosal ischemia or sore throat because of the short duration. However the tube was withdrawn with the cuff filled with saline, and the cuff pressure may around 30 cmH2 O. Would the frictional forces between the cuff and the mucosa injure the tracheal membrane?
夽 Funding: Funded by Department of Anaesthesiology, West China Hospital. http://dx.doi.org/10.1016/j.resuscitation.2014.11.032 0300-9572/© 2015 Published by Elsevier Ireland Ltd.
Conflict of interest statement No financial and personal relationships with other people or organizations that could inappropriately influence (bias) the work. References 1. Tessaro MO, Salant EP, Arroyo AC, Haines LE, Dickman E. Tracheal rapid ultrasound saline test (T.R.U.S.T.) for confirming correct endotracheal tube depth in children. Resuscitation 2014, http://dx.doi.org/10.1016/j.resuscitation.2014.08.033. 2. Raphael DT, Conard 3rd FU. Ultrasound confirmation of endotracheal tube placement. J Clin Ultrasound 1987;15:459–62. 3. Uya A, Spear D, Patel K, Okada P, Sheeran P, McCreight A. Can novice sonogra-phers accurately locate an endotracheal tube with a saline-filled cuff in a cadavermodel? A pilot study. Acad Emerg Med 2012;19:361–4.
Yansong Li Jing Wang Xinchuan Wei ∗ Department of Anaesthesiology, West China Hospital, China ∗ Corresponding
author at: Department of Anaesthesiology, West China Hospital, Chengdu 610041, China. E-mail addresses: [email protected] (Y. Li), [email protected] (J. Wang), [email protected] (X. Wei). 24 November 2014
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Letter to the Editor Confirmation of the depth of the endotracheal tube: Where should the cuff be?夽 Sir, In a prospective feasibility study, Tessaro et al. concluded that sonographic visualization of a saline-inflated ETT cuff at the suprasternal notch, which was named tracheal rapid ultrasound saline test (T.R.U.S.T.), is an accurate and rapid method for confirming correct endotracheal tube (ETT) insertion depth in children.1 It was a very novel idea to confirm the depth of the endotracheal tube in children. I am so excited to read it and I have two questions about the method. The first question was about the proper depth of the cuff. As the author described, they withdrew the ETT until the appearance of the saline-inflated cuff at the level of the sternal notch, and the mean ETT tip position was 2.7 cm above the carina. Some studies also demonstrated that put the cuff at the sternal notch could keep the ETT at the proper depth.2,3 However, the length of the cuff of the endotracheal tube ranged from 1.5 to 3 cm, none of the study demonstrated how long we should keep the cuff above the sternal notch. Part of the cuff or the entire cuff? Is there a standard? The second problem was the tracheal mucosal lesion. Although the pressure exerted by the cuff on the mucosa may exceed capillary perfusion pressure, it may not lead to mucosal ischemia or sore throat because of the short duration. However the tube was withdrawn with the cuff filled with saline, and the cuff pressure may around 30 cmH2 O. Would the frictional forces between the cuff and the mucosa injure the tracheal membrane?
夽 Funding: Funded by Department of Anaesthesiology, West China Hospital. http://dx.doi.org/10.1016/j.resuscitation.2014.11.032 0300-9572/© 2015 Published by Elsevier Ireland Ltd.
Conflict of interest statement No financial and personal relationships with other people or organizations that could inappropriately influence (bias) the work. References 1. Tessaro MO, Salant EP, Arroyo AC, Haines LE, Dickman E. Tracheal rapid ultrasound saline test (T.R.U.S.T.) for confirming correct endotracheal tube depth in children. Resuscitation 2014, http://dx.doi.org/10.1016/j.resuscitation.2014.08.033. 2. Raphael DT, Conard 3rd FU. Ultrasound confirmation of endotracheal tube placement. J Clin Ultrasound 1987;15:459–62. 3. Uya A, Spear D, Patel K, Okada P, Sheeran P, McCreight A. Can novice sonogra-phers accurately locate an endotracheal tube with a saline-filled cuff in a cadavermodel? A pilot study. Acad Emerg Med 2012;19:361–4.
Yansong Li Jing Wang Xinchuan Wei ∗ Department of Anaesthesiology, West China Hospital, China ∗ Corresponding
author at: Department of Anaesthesiology, West China Hospital, Chengdu 610041, China. E-mail addresses: [email protected] (Y. Li), [email protected] (J. Wang), [email protected] (X. Wei). 24 November 2014
