PulmCrit (EMCrit)
PulmCrit - November 21, 2016 - By Josh Farkas
"According to Napoleon, “the moment of greatest vulnerability is the instant immediately after victory.” In airway management, this instant occurs immediately after placement of the endotracheal tube. There is a risk of relaxing and overlooking critical details. Meanwhile, this is often the point when the patient’s blood pressure and saturation nadir...
- Although ETT depth is generally overlooked, it can be important. Inadvertent endobronchial intubation exposes the patient to a risk of hypoxemia, atelectasis, and pneumothorax.
- Our usual strategy for determining ETT depth is error-prone:
- (a) Traditionally it has been taught that ETT depth should be 23 cm in men and 21 cm in women. This rule may be dangerous in people of unusual height or non-Caucasian ethnicity.
- (b) Chest auscultation is insensitive for detecting endobronchial intubation.
- ETT depth may be predicted based on the patient’s height. This has been validated among both men and women, across different ethnicities, and among both adults and taller children.
- A height-based algorithm can easily be implemented by attaching a table to determine ETT depth and tidal volume to your airway checklist (example below). This table may simultaneously improve two aspects of post-intubation safety."