Preventing Endotracheal Cuff Rupture during Tracheostomy

Objective 1) To demonstrate the importance of endotracheal tube (ETT) positioning in avoiding complications of ETT cuff penetration during tracheostomy. 2) To describe the author’s technique of ETT positioning. 3) To determine the probability of cuff penetration utilizing the technique in a 3D‐computed tomography model. Method From July 2008 to January 2012, 89 patients who had undergone tracheostomy using the mentioned technique in a tertiary hospital setting were evaluated. One hundred fifty random patient CT scans were chosen, measurements were taken, and probability of cuff penetration during virtual tracheostomy was generated. Primary outcome was ETT cuff penetration. Results Over the period studied, 85/89 patients underwent tracheotomy without ETT cuff rupture by positioning the ETT just proximal to the carina after neck extension. After evaluating 150 random 3D‐CT scans, it was determined that the average distance between the tracheotomy to superior aspect of cuff was 80 mm in males and 63.8 mm in females when a 6.5 sized ETT was utilized, and 70.2 mm in males and 54 mm in females when a 7.5 ETT was utilized. Virtual tracheotomy between the second and third tracheal rings resulted in no probability of inadvertent ETT cuff rupture. Conclusion ETT cuff rupture is a common occurrence that may result in disastrous intraoperative complications during tracheostomy. This study serves to underscore the importance of ETT positioning and provides radiologic evidence for the author’s approach. Distal ETT positioning should be strongly considered for avoiding problems of ETT cuff rupture during tracheostomy.