Pressure Over Nasotracheal Intubation Related Nasal Alar Injury

Study Overview
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Brief Summary
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Nasotracheal intubation can cause injury and hemorrhage of nasal mucosa and nasal alar. The investigators measure the actual pressure at the angle between nasotracheal tube and nasal alar, analyze the relationship of clinical signs and symptoms to build up optimal clinical routines.

Detailed Description
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While assisting ventilation during general anesthesia or other reasons, patients are often intubated with endotracheal tube to secure airway. Endotracheal tube can be placed trans-orally or trans-nasally according to surgical conditions, anatomical considerations and nursing needs. Except inadequate cuff pressure related complication, nasotracheal intubation can cause dysfunction of nasal mucosal cilia, injury and hemorrhage of nasal mucosa, turbinate avulsion, obstruction of nasal airway, sinusitis and compression and injury of nasal alar, resulting in local erythema, ischemia, pressure sore, necrosis, tissue damage and may affect appearance. Previous studies focus on the process of nasal tracheal intubation, aim to reduce mucosal injury and hemorrhage via specific intubation tool, special endotracheal tube design, lubricant and so on. However, evidences in preventing nasal alar injury are limited, in which injuries are mostly prevented by self-made special endotracheal tube and artificial leather. In general, the etiology of tissue damage is compression pressure exceeding local capillary perfusion pressure, resulting in reduced perfusion, ischemia and necrosis. Clinically, health providers prevent the injury by standardized endotracheal tube fixation and/or artificial leather at sites with potential compression. But the extend of the effect of endotracheal tube to trachea mucosa varies, range of pressure affecting capillary perfusion pressure are not yet defined, and no routine monitoring for dermis compression. Thus, endotracheal tube related skin damage is an important clinical issue without best standard operating procedure. In this study, the investigators will place a pressure sensor at the angle of nasotracheal tube, measure the actual pressure, define the sites of compression and its pressure, analyze the relationship of clinical signs and symptoms, pressure, and duration of nasotracheal intubation, and build up optimal clinical routines.

Official Title
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Monitoring the Pressure Over Nasotracheal Intubation and Related Nasal Alar Injury

Conditions
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Intubation Complication, Pressure Injury

Intervention / Treatment
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* Device: pressure sensor


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists (ASA) Physical classification I & II patients undergo general anesthesia and receive intratracheal intubation through nose elective surgery Exclusion Criteria: with known nasal injury already intubation before induction surgery on the nose emergent operation

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Nasal intubation with pressure sensor<br>anesthetized patient with nasotracheal intubation | Device: pressure sensor<br>* Pressure sensor at the angle of intratracheal tube and nasal alar<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| appearance of nose | intact or redness ; if redness then, go through NPUAP classification | from induction to one day after surgery | 
| VAS | Patient's VISUAL ANALOG SCALE (VAS) for pain of the nose after surgery: no pain (0 - 4 mm), mild pain (5- 44mm), moderate pain (45-74 mm), and severe pain (75-100 mm) | from induction to one day after surgery | 
| pressure between nose and intratracheal tube | pressure between nose and intratracheal tube detected by pressure sensors | during intubation | 
| NPUAP classification | The National Pressure Ulcer Advisory Panel stage | from induction to one day after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nasotracheal intubation, nasal alar injury