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Stylet Bend Angles and Tracheal Tube Passage Using a Straight‐to‐cuff Shape
Author(s) -
Levitan Richard M.,
Pisaturo James T.,
Kinkle William C.,
Butler Kenneth,
Everett Worth W.
Publication year - 2006
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1197/j.aem.2006.06.058
Subject(s) - medicine , stylet , cuff , tracheal tube , tube (container) , anatomy , intubation , orthodontics , surgery , mechanical engineering , engineering
Objectives Malleable stylets improve maneuverability and control during tube insertion, but after passage through the vocal cords the stiffened tracheal tube may impinge on the tracheal rings, preventing passage. The goal of this study was to assess insertion difficulty with styletted tubes of different bend angles. Methods Tube passage was assessed with four different bend angles (25°, 35°, 45°, and 60°) using straight‐to‐cuff–shaped tubes. In two separate airway procedure classes, 16 operators in each class (32 total) placed randomly ordered styletted tubes of the different angles into eight cadavers (16 total). Operators subjectively graded the ease of tube passage as no resistance, some resistance, or impossible to advance. Results No resistance was reported in 69.1% (177/256) at 25°, in 63.7% (163/256) at 35°, in 39.4% (101/256) at 45°, and in 8.9% (22/256) at 60°. Tube passage was impossible in 2.3% of insertions (6/256) at 25°, in 3.5% (9/256) at 35°, in 11.3% (29/256) at 45°, and in 53.9% (138/256) at 60°. The odds ratios of impossible tube passage for 35°, 45°, and 60° vs. 25° were 1.52 (95% confidence interval [CI] = 0.55 to 4.16), 5.32 (95% CI = 2.22 to 12.71), and 48.72 (95% CI = 21.35 to 111.03), respectively. Conclusions Bend angles beyond 35° with straight‐to‐cuff styletted tracheal tubes increase the risk of difficult and impossible tube passage into the trachea. The authors did not compare different stylet stopping points, stylets of different stiffness, or tracheal tubes with different tip designs, all variables that can affect tube passage.