Prevention of Endotracheal Tube Migration by Cuff Palpation During Robotic Surgical Procedure

Overview

After intubation, the endotracheal tube was finally fixed after palpating endotracheal cuff at three sites (just below the cricoid cartilage, at suprasternal level and just below suprasternal notch). Fibre optic bronchoscopy will be done to find distance between tip of endotracheal tube and carina. This distance will be measured repeatedly, after pneumoperitoneum, after trendelenburg position and after making the patient supine at the end of surgery. Change in the distance will be noted.

Full Title of Study: “To Evaluate “Three Point Cuff Palpation Technique” for Assessing Optimal Depth of Endotracheal Tube Placement.”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: January 19, 2021

Detailed Description

The endotracheal tube (ETT) will be placed according to the black mark on the tube, post-intubation, the tube will be finally fixed after palpating endotracheal cuff at three sites (below cricoid cartilage, at suprasternal level and just below suprasternal notch). ETT cuff position will be scanned by sonography of airway to confirm the position of the proximal end of the ETT cuff. Fibre optic bronchoscopy will be done to find distance between tip of endotracheal tube and carina. This distance will be measured repeatedly 5 minutes after pneumoperitoneum, 10 minutes after trendelenburg position and 10 minutes after making the patient supine at the end of surgery. Change in the distance will be noted to confirm the migration of ETT.

Interventions

  • Procedure: Three point cuff palpation technique
    • the ETT is finally positioned according to the Three point cuff technique.

Arms, Groups and Cohorts

  • Three point cuff palpation and Blck mark line technique
    • In “Three point cuff palpation technique” the cuff will be palpated just below the cricothyroid membrane,at the level of suprasternal notch and below the suprasternal notchand the tube is re-positioned in case of any discrepancy between the black mark line technique and three point cuff at three different over the trachea.

Clinical Trial Outcome Measures

Primary Measures

  • Measure the distance between tip of endotracheal tube and Carina by fiber-optic bronchoscopy and measuring scale at various phases of robotic surgical procedure.
    • Time Frame: Throughout robotic surgical procedure, immediately after intubation, 5 minute after pneumoperitoneum, 10 minutes after trendelenburg position and after dedocking and making patient supine.pneumoperitoneum.
    • proper endotracheal tube placement is labelled when the distance between the tip of tube and Carina is more than 2.5 cm, after placement the tube by three point cuff palpation technique, its position will be assessed at respective time points.

Secondary Measures

  • find the effect of cricod cartilage and supra-sternal distance on endotracheal tube tip to Carina distance.
    • Time Frame: Throughout robotic surgical procedure, immediately after intubation, 5 minute after pneumoperitoneum, 10 minutes after trendelenburg position and after dedocking and making patient supine.
    • cricoid cartilage to suprasternal distance changes with the position of neck, so it could affect the distance between the endotracheal tube tip and carina as the position of patient changes during various robotic surgical steps.

Participating in This Clinical Trial

Inclusion Criteria

  • Robotic uro-oncological surgical procedures of perineum – Robotic gynae-oncological surgical procedures of perineum Exclusion Criteria:

  • Upper airway fibrosis or tracheal stenosis – Large neck swelling distorting or deviating the trachea. – Head and neck surgeries – Laryngeal and tracheal tumour – Tracheal surgery – Previous tracheostomy – previous radiation treatment of neck

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 70 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Rajiv Gandhi Cancer Institute & Research Center, India
  • Provider of Information About this Clinical Study
    • Principal Investigator: Amit Kumar Mittal, Consultant in-charge – Rajiv Gandhi Cancer Institute & Research Center, India
  • Overall Official(s)
    • Amit Kr Mittal, MD, Principal Investigator, Rajiv Gandhi Cancer Institute and Research centre
  • Overall Contact(s)
    • Amit Kr Mittal, M.D, 01147022323, amitrgci@gmail.com

References

Chang CH, Lee HK, Nam SH. The displacement of the tracheal tube during robot-assisted radical prostatectomy. Eur J Anaesthesiol. 2010 May;27(5):478-80. doi: 10.1097/EJA.0b013e328333d587.

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