Can J Anesth/J Can Anesth (2015) 62:832
DOI 10.1007/s12630-015-0359-2
CORRESPONDENCE
Confirmation of endotracheal tube depth using ultrasound
in adults
Yansong Li, MD • Jing Wang, MD •
Xinchuan Wei, MD
Received: 28 January 2015 / Accepted: 3 March 2015 / Published online: 12 March 2015
Ó Canadian Anesthesiologists’ Society 2015
To the Editor, membranous posterior wall of the tracheal rings may act to
We have read with great interest the article by McKay relieve the ETT cuff pressure if the cuff is overinflated,
et al.1 It is a welcome investigation into the confirmation of whereas the complete cricoid cartilage could not.5
endotracheal tube (ETT) depth using ultrasound. In the
study, the correct placement of the ETT was determined Conflicts of interest None declared.
when its tip was [ 2.5 cm above the carina with the ETT
Funding Funded by the Department of Anaesthesiology, West
cuff still below the cords. The ETT was fixed when its tip China Hospital.
reached the sternal notch. As the manubriosternal joint is a
well-known surface landmark for the carina,2 if the tip of
the ETT is at the level of the sternal notch, it may be too far
above the carina. Because the distance between the upper References
margin of the cuff and the tip is about 6.5 cm in adults, the
cuff may be too close to the vocal cords. Several other 1. McKay WP, Wang A, Yip K, Raazi M. Tracheal ultrasound to
assess endotracheal tube depth: an exploratory study. Can J Anesth
studies, including those using ultrasound or palpation, have
2015; DOI: 10.1007/s12630-015-0313-3.
revealed that the depth of the ETT was correct when the 2. Williams PL, Bannister LH, Berry MM,et al. Gray’s Anatomy. The
cuff, rather than the tip, was placed at the sternal notch.3,4 Anatomical Basis of Medicine and Surgery, 38th Edition.
As MacKay et al. did not record the position of the ETT Edinburgh, Churchill Livingstone; 1995: 1677.
3. Uya A, Spear D, Patel K, Okada P, Sheeran P, McCreight A. Can
cuff in their study, we are concerned that the cuff may have
novice sonographers accurately locate an endotracheal tube with a
been too close to the vocal cords, thus increasing the risk of saline-filled cuff in a cadaver model? A pilot study. Acad Emerg
vocal cord impingement as well as unplanned extubation. Med 2012; 19: 361-4.
We have found it relatively easy to locate the position of 4. Pollard RJ, Lobato EB. Endotracheal tube location verified
reliably by cuff palpation. Anesth Analg 1995; 81: 135-8.
the cuff and the vocal cords by ultrasound, and in so doing,
5. Chong DY, Greenland KB, Tan ST, Irwin MG, Hung CT. The
if the ETT tip is far enough away from the carina, we can clinical implication of the vocal cords-carina distance in
increase the ETT depth to keep the cuff away from the anaesthetized Chinese adults during orotracheal intubation. Br J
cords. We also agree with the view that subglottic damage Anaesth 2006; 97: 489-95.
by the ETT cuff can be minimized if the upper margin of
the cuff is distal to the cricoid cartilage. This is because the
This letter is accompanied by a reply. Please see Can J Anesth 2015;
62: this issue.
Y. Li, MD J. Wang, MD X. Wei, MD (&)
Department of Anaesthesiology, West China Hospital, Cheng
Du, Sichuan, China
e-mail:
[email protected]123
