The effect of nasal tube stabilization on pressure between tube and nose

doi:10.19438/j.cjoms.2021.04.011

Abstract

Abstract: PURPOSE: This clinical trial was performed to evaluate the effect of nasal tube stabilization (NTS) on pressure between tube and nose(PTN) in both supine and neck extension position. METHODS: Twenty-four ASAⅠorⅡ adult patients scheduled for oral and maxillofacial surgeries requiring naso tracheal intubation(NTI) were randomly assigned to intubate with either wire-reinforced or Ring-Adair-Elwyn tube. Thin film pressure sensor was used to measure PTN before and after NTS in both supine and neck extension position. Statistical analysis was performed with Graphpad Prism 9.0 software package. RESULTS: The PTN of wire-reinforced tubes were 51 mmHg higher than that of RAE tubes in supine position before NTS (P=0.005), and 68 mmHg higher than that in extension position before NTS (P=0.0007). In wire-reinforced tube group before NTS, the PTN of neck extension position increased by 24 mmHg compared with supine position (P=0.0005). After NTS, the PTN in supine and neck extension position was comparable (P=0.1514). NTS significantly reduced PTN in both supine (P=0.0005) and neck extension position (P=0.0005); while in RAE tube group before NTS, the PTN in supine and neck extension position was comparable (P=0.3394). After NTS, the pressure in supine and neck extension position was comparable(P=0.7910). NTS also significantly reduced PTN in both supine (P=0.0005) and neck extension position (P=0.0005). CONCLUSIONS: NTS effectively reduced PTN of both wire-reinforced and RAE tubes regardless of supine or neck extension position. RAE tube also significantly reduced PTN compared with wire-reinforced tube.

Key words: Nasal ala, Tracheal tube, Endotracheal intubation, Pressure, Ulcer

CLC Number:

R782.05

HU Wen-yue, LYU Xiang, SUN Yu. The effect of nasal tube stabilization on pressure between tube and nose[J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(4): 345-349.

References

[1] Hall CE, Shutt LE.Nasotracheal intubation for head and neck surgery[J]. Anaesthesia, 2003, 58(3): 249-256.
[2] Huang TT, Tseng CE, Lee TM, et al.Preventing pressure sores of the nasal ala after nasotracheal tube intubation: from animal model to clinical application[J]. J Oral Maxillofac Surg, 2009, 67(3): 543-551.
[3] Singh R, Sood N, Kerai S, et al.Use of merocel^® aids in prevention of nasal pressure ulcers following nasal intubation: case series of 33 patients[J]. Indian J Anaesth, 2017, 61(6): 513-515.
[4] Edsberg LE, Black JM, Goldberg M, et al.Revised national pressure ulcer advisory panel pressure injury staging system: revised pressure injury staging system[J]. J Wound Ostomy Continence Nurs, 2016, 43(6): 585-597.
[5] Coyer FM, Stotts NA, Blackman VS.A prospective window into medical device-related pressure ulcers in intensive care[J]. Int Wound J, 2014, 11(6): 656-664.
[6] Rashvand F, Shamekhi L, Rafiei H, et al.Incidence and risk factors for medical device-related pressure ulcers: the first report in this regard in iran[J]. Int Wound J, 2020, 17(2): 436-442.
[7] Jackson D, Sarki AM, Betteridge R, et al.Medical device-related pressure ulcers: a systematic review and meta-analysis[J]. Int J Nurs Stud, 2019, 92: 109-120.
[8] Nelke KH, Pawlak W, Łuczak K.Abdominal retraction pad used in orthognathic surgery: a novel technique for nasotracheal tube stabilization during Le Fort I osteotomy[J]. J Craniofac Surg, 2016, 27(7): 1842-1844.
[9] Baek RM, Song YT.A practical method of surgical draping using the preformed RAE (Ring-Adair-Elwyn) nasotracheal tube and the mayo table in maxillofacial surgery[J]. Plast Reconstr Surg, 2003, 112(5): 1484-1485.
[10] Likitlersuang J, Leineweber MJ, Andrysek J.Evaluating and improving the performance of thin film force sensors within body and device interfaces[J]. Med Eng Phys, 2017, 48: 206-211.
[11] Komasawa N, Mihara R, Imagawa K, et al.Comparison of pressure changes by head and neck position between high-volume low-pressure and taper-shaped cuffs: a randomized controlled trial[J]. Biomed Res Int, 2015: 386080.
[12] Jin SJ, Choi YJ, Park SW, et al.Correlation between changes in thyromental distance and distance of migration of oral Ring-Adair-Elwyn tubes during neck extension with a shoulder positioner in patients undergoing neck procedures[J]. J Int Med Res, 2015, 43(3): 460-467.
[13] Liu R, Kwok YL, Li Y, et al.Objective evaluation of skin pressure distribution of graduated elastic compression stockings[J]. Dermatol Surg, 2005, 31(6): 615-624.
[14] Cordovani D, Russell T, Wee W, et al.Measurement of forces applied using a macintosh direct laryngoscope compared with a glidescope video laryngoscope in patients with predictors of difficult laryngoscopy: a randomised controlled trial[J]. Eur J Anaesthesiol, 2019, 36(3): 221-226.
[15] Barakat-Johnson M, Lai M, Wand T, et al.The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review[J]. J Wound Care, 2019, 28(8): 512-521.
[16] Siddiqui AS, Dogar SA, Lal S, et al.Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery[J]. J Anaesthesiol Clin Pharmacol, 2016, 32(1): 49-53.
[17] Brasileiro BF, Van Sickels JE.Nasal alar pressure ulcer after orthognathic surgery: clinical presentation and preventive recommendations[J]. J Craniofac Surg, 2019, 30(6): e533-e535.
[18] Huang WS, Chou TD, Chen TM, et al.Nasal ala pressure sores: easily missed complications of nasotracheal tube intubation[J]. J Med Sci, 2002, 22(3): 101-104.
[19] Tsukamoto M, Kobayashi M, Yokoyama T.Risk factors for pressure ulcers at the ala of nose in oral surgery[J]. Anesth Prog, 2017, 64(2): 104-105.
[20] Daniel RK, Wheatley D, Priest D.Pressure sores and paraplegia: an experimental model[J]. Ann Plast Surg, 1985, 15(1): 41-49.
[21] Hedrick-Thompson JK.A review of pressure reduction device studies[J]. J Vasc Nurs, 1992, 10(4): 3-5.