Endotracheal intubation is one of the important procedures in ED and various fields. Endobronchial intubation can lead to hypoxemia secondary to tension pneumothorax of intubated side and atelectasis of contralateral side. The placement of tube
beyond
the vocal cords may result in inadvertent extubation, larygeal spasm and aspiration pneumonia. The conformation methods of endotracheal intubation are auscultation of the chest, observation of a vapor trail, oximetry and capnography, and
radiologic
evaluation. Owen and associated recommended that oral intubation tubes at the upper incisor teeth at the 23cm in men and the 21cm in women of average adult size would have led to proper placement. We studied that whether the proper depth of
endotracheal
tube in American is appropriate to Korean.
We studied adult patients admitted to ED (of both hospitals during March in 1995. Endotracheal tubes in men were positioned at the 23cm and women had positioned at the 21cm at the upper incisor teeth. The distance of the tip of the endotracheal
tube to
the tracheal carina on the postintubation chest X-ray then determined. Correct placement of intubation was defined with the tip of the tube≥3cm above the carina and below the level of the larynx.
Fifty adult patients were enrolled in the study ; 29 men (58%) and 31 women (42%). Mean height and weight were 170±5.2cm, 68±9kg in men and 158±6.5cm, 56±10kg in women. Reasons for intubation were ; respiratory failure(38%), trauma(16%),
increased
intracramial pressare(16%), drug intoxication(12%), shock(8%), cardiac arrest(7%)and others(8%). The mean distance from the tip to carina on chest X-ray was 4.13±1.5cm in men and 3.45±2.1cm in women. Proper position was 27/29(93%) in men,
14/21(67%)
in women or 41/50(82%). This means the placement of endotracheal tube of our patients was positioned deeper than prion study group(97.6%). (p<.05)
We recommend that the 22cm tube mark for men and 20cm tube mard for women at upper incisor teeth would have led to proper placement in Korean adult patient.
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