TITLE:
Endotracheal Tube Displacement during Cardiac Surgery in Infants: A Retrospective Cohort Study of Its Incidence and Predictors
AUTHORS:
Atsuhiro Sekiguchi, Akira Kitamura, Miki Tsujita, Yuki Shiko, Hideyuki Nakagawa
KEYWORDS:
Endotracheal Tube Disposition, Pediatric Cardiac Surgery, Neonates, Infants, Risk Factor
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.12 No.7,
July
19,
2022
ABSTRACT: Introduction: With the traction on the trachea and intrathoracic manipulation during cardiac surgery, the position of the endotracheal tube (ETT) might be changed as compared to before surgery. Migration of the ETT during pediatric cardiac surgery is particularly problematic in infants. Methods: In this retrospective cohort study, chest X-rays were taken in the operating room just before and after surgery. The position of the ETT among all infants under 1 year of age who underwent cardiac surgery between December 2017 to December 2019 was evaluated. The displacement of the ETT position was examined by measuring the position of the tube tip from the tracheal bifurcation on a chest X-ray, and the relationship between surgery-related factors (age, height, weight, sex, surgery time, cardiopulmonary bypass, tube size, use of tube cuff) was analyzed. Results: Eighty-eight of the 141 patients were enrolled. There was a significant proximal displacement of the ETT tip during cardiac surgery. The distance from the carina to the tube tip after surgery was long, on average 2.5 mm, compared to that before surgery (P = 0.013). Cephalad displacement of the ETT either ≥5 mm or ≥2.5 mm was found in 28 and in 38 out of 88 infants after surgery, respectively. After performing multivariate analysis, the use of un-cuffed ETT was the sole exploratory variable predictive of tube tip displacement (OR 0.34, 95% CI 0.10 - 0.93 if ≥5 mm; and OR 0.24, 95% CI 0.08 - 0.75 if ≥2.5 mm displacement; P = 0.04 and 0.01, respectively). Conclusion: Proximal displacement of the ETT during cardiac surgery occurs more frequently in infants with un-cuffed ETT.