Correct Endotracheal Tube Placement Using Topographical Landmarks

Study Overview
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Brief Summary
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An optimal endotracheal tube depth is ideally required for preventing the complications associated with mal-positioning of the endotracheal tube. The topographical technique of tube placement considering the individual's morphometric dimensions could help to provide optimal tube placement. hence, to evaluate the efficacy of the topographical technique in providing the optimal tube placement this study will be conducted.

Detailed Description
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The trachea is a dynamic organ and its length varies by various static and dynamic factors leading to changing the tracheal length and variable endotracheal tube tip to carina (Ti-Ca) distance. Hence, upholding optimal Ti-Ca distance during changing tracheal length is of utmost importance to prevent complications associated with endotracheal tube (ETT) mal-positioning. When the length of ETT, which is to be inserted inside the trachea, is calculated as per an individual's tracheal morphometric dimensions, the appropriate depth of placement could be achieved and tube malpositioning can be prevented. In the topographical landmark technique, an individual tracheal length is estimated by measuring the various distance from mid-thyroid level (corresponds to vocal cords) to manubriosternal joint (corresponds to carina) in the sagittal plane. After estimating the tracheal length, tip to carina distance of 3cm was deducted from the estimated length of the trachea to provide the distance of the endotracheal tube to be kept beyond the vocal cords. Hence, the investigators planned this study to find the utility and reliability of the topographical landmark technique compared to the conventional intubation guide mark technique in providing the appropriate depth of endotracheal tube placement.

Official Title
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To Evaluate the Appropriate Depth of Endotracheal Tube Placement Guided by Topographical Landmarks

Conditions
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Intubation, Intratracheal, Anatomic Landmarks

Intervention / Treatment
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* Device: Topographical landmark technique of endotracheal tube placement
* Device: Intubation guide mark technique of endotracheal tube placement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Age group of 18-75 years ASA physical status I-III patients Oral intubation for general anesthesia Exclusion Criteria: • Patient with upper airway fibrosis Tracheal stenosis or tracheal surgeries Previous head and neck surgeries Contracture neck or irradiated neck Large neck swelling distorting or deviating the trachea Laryngeal or tracheal tumor Intubations requiring flexo-metallic tubes Patient refusal

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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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: All enrolled patients will be intubated by either topographical landmarks of individual tracheal dimensions or by the conventional intubation guide method.
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Topographical landmark technique<br>Surface anatomic landmarks of an individual's trachea will be measured from the mid-thyroid level (corresponds to vocal cords) to manubriosternal joint (corresponds to carina) in the sagittal plane to estimate tracheal length. Three centimeters will be deducted from the estimated tracheal length to provide the length of the endotracheal tube from the tube tip to be inserted inside the trachea. | Device: Topographical landmark technique of endotracheal tube placement<br>* An endotracheal tube will be placed inside the trachea after measuring the individual's estimated tracheal dimensions.<br>|
| Active Comparator: Intubation guide mark technique<br>Already established and commonly practiced technique, in this technique, the guide mark present above the proximal end of the endotracheal tube cuff will be placed just beyond the vocal cords. | Device: Intubation guide mark technique of endotracheal tube placement<br>* An endotracheal tube will be placed in this group by using the intubation guide mark.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Endotracheal tube position inside the trachea | Tip to carina distance will be measured by fiber optic bronchoscopy to classify the optimal or suboptimal tube placements in both groups | through study completion approximately at six months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Endotracheal tube placement, Topographical landmarks of trachea