Preventing Cuff Rupture During Tracheostomy: Importance of Endotracheal Tube Positioning

Objective: The objective of our study is to describe the technique of distal endotracheal tube (ETT) positioning for avoiding cuff rupture and validate the technique in a virtual tracheostomy model. Methods: A prospective nonrandomized case series of 129 patients who had undergone tracheostomy using the senior author's technique were evaluated. Primary outcome was ETT cuff rupture. One hundred normal patient computed tomography (CT) scans were used to generate a virtual tracheostonny model, and the probability of cuff rupture, among other values, was obtained. Results: One hundred twenty-three of 129 patients underwent tracheostomy without cuff rupture when the distal tip of the ETT was placed just proximal to the carina. After analysis of 100 3-dimensional CT scans, the average distance from the tracheotomy to the superior aspect of the cuff was 54.6 mm in men and 39.87 mm in women when a 6.5-size ETT was used, and 44.8 mm in men and 30.07 mm in women when a 7.5-size ETT was used. Virtual tracheotomy between the second and third tracheal rings resulted in no probability of inadvertent ETT cuff rupture. Conclusion: Distal ETT positioning during tracheostomy should be considered for avoiding inadvertent ETT cuff rupture.