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The Occurrence and Risk Factors of Inappropriately Deep Tip Position of Microcuff Pediatric Endotracheal Tube During PICU Stay: A Retrospective Cohort Pilot Study*

Matsuoka, Wakato MD1; Ide, Kentaro MD1; Matsudo, Takahiro MD1; Kobayashi, Tohru MD, PhD2; Nishimura, Nao MD1; Nakagawa, Satoshi MD1

Pediatric Critical Care Medicine: November 2019 - Volume 20 - Issue 11 - p e510-e515
doi: 10.1097/PCC.0000000000002097
Online Clinical Investigations
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Objectives: Cuffed endotracheal tubes are being used increasingly for pediatric patients on mechanical ventilation. Appropriate placement of the tube tip for Microcuff (Kimberley-Clark, Roswell, GA) pediatric endotracheal tube is guided by the intubation depth mark on the device. However, inappropriately deep tip position is sometimes observed during PICU stay. The purpose of this study was to assess the occurrence and risk factors of inappropriately deep tip position of Microcuff pediatric endotracheal tube during PICU stay.

Design: A retrospective cohort study.

Setting: The PICU at the National Center for Child Health and Development, one of the largest tertiary pediatric hospitals in Japan.

Patients: All patients on mechanical ventilation with Microcuff pediatric endotracheal tube admitted between February 1, 2015, and July 31, 2016, were enrolled.

Interventions: None.

Measurements and Main Results: The primary outcome was the occurrence of inappropriately deep tip position, defined as a position of the tube tip less than 5 mm above the carina on a chest radiograph. There were 179 cases (157 patients) requiring mechanical ventilation with Microcuff pediatric endotracheal tube during the study period. An inappropriately deep tip position was found in 42 cases (23.5%), including bronchial intubation in 13 cases (7.3%). In multivariate analysis, height in cm (odds ratio, 0.93; p < 0.001), history of abdominal disease or previous abdominal surgery (odds ratio, 4.38; p = 0.004), and oversized endotracheal tube (odds ratio, 2.93; p = 0.042) were found to be independent risk factors.

Conclusions: The occurrence of inappropriately deep tip position of Microcuff pediatric endotracheal tube during PICU stay was 23.5%. The possibility of an inappropriately deep tip position should be considered whenever patients with the above risk factors, a history of abdominal disease or previous abdominal surgery, and small children are treated or when oversized endotracheal tubes are used.

1Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan.

2Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo, Japan.

*See also p. 1101.

Dr. Matsuoka reviewed the electronic health records and wrote the draft of the article. Dr. Ide conceptualized and designed the study, supervised the review of the patient data, and wrote the final article. Dr. Matsudo co-reviewed the patients’ chest radiographs. Dr. Kobayashi supervised the data analysis. Drs. Nishimura and Nakagawa conceptualized and designed the study. All the authors read and approved the final article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: ide-k@ncchd.go.jp

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies