ABEA025 - Tracheal Tube Selection In Adults: A Systematic Review And Expert Opinion
Saturday, April 30, 2022
8:27 AM – 8:33 AM CT
Location: Landmark D
Noel M Phan, Benjamin Tweel, Diana Kirke, Mark Courey, Alexander Hillel, Karla O'Dell, James Casey, Alexander Gelbard, Gregory Postma
Icahn School of Medicine at Mount Sinai; Johns Hopkins University School of Medicine; Keck School of Medicine of USC; Vanderbilt University School of Medicine; Medical College of Georgia at Augusta University
Objective: Provide those who manage adult patients with laryngotracheal stenosis (LTS) with information relevant to its risk factors, prevention, pathogenesis and outcomes.
Method: A comprehensive search strategy using both keywords and index terms was executed in the Ovid MEDLINE and Ovid Embase databases in June 2020 and again in May 2021 to identify articles relating to endotracheal tube (ETT) intubation and associated laryngeal injury.
Results: A total of 435 potentially eligible publications were identified between June 2000 and May 2021. Sixty-six studies fit the criteria and were included in this study while 369 studies excluded. There were 8 studies that discussed post-operative sore throat, 15 on laryngotracheal stenosis, 13 on mechanism of injury, 21 on local injury, 7 studies regarding anatomic measurements, 6 on cuff pressure, and 4 studies on post-intubation hoarseness. Larger tube size was associated with laryngotracheal stenosis, post-intubation dysphonia, dysphagia and postoperative sore throat. Endotracheal intubation is the most common cause of laryngotracheal stenosis (LTS), with reported rates ranging from 54.7% to 90%.
Conclusion: Despite the variability of various studies, outcome measures and subjects there is significant evidence as well as expert opinion that larger endotracheal tubes are associated with a number of adverse breathing and swallowing outcomes. Endotracheal tube size is one of the few potentially modifiable factors we have to mitigate post intubation morbidity. Therefore, we recommend using no greater than a 6.5-7.0 size ETT in women and no greater than a 7.0-7.5 size ETT in men in most circumstances.