Retrospective computed tomography analysis of endotracheal tube constriction and mispositioning in cats and dogs

Abstract

ObjectiveTo discover the prevalence of endotracheal tube (ETT) constriction and rostral and caudal mispositioning in anaesthetized cats and dogs, and to identify associated risk factors. Study designRetrospective analysis. AnimalsA total of 146 cats and 670 dogs. MethodsComputed tomography images of the head/neck/thorax from orotracheally intubated cats and dogs were visually assessed for constriction or mispositioning of the ETT. If constriction was present, measurements of the cross-sectional area (CSA) of the ETT lumen at constricted and un-constricted locations were compared. Location and cause of constriction were noted and the expected increase in resistance to gas flow was calculated. Animal information was collected from clinical records. Normality of continuous variables was assessed via the Shapiro–Wilk test. Chi-square tests examined associations between variables. Kendall’s tau-b test was performed between measured ETT size and degree of constriction. ResultsThe ETT extended rostrally beyond incisors in 52% of cases; the connector was within the oral cavity in 19% of cases. The ETT extended beyond the first rib in 25.5% of cases. The prevalence of ETT constriction was 22.7%. Median reduction in CSA was 7.68% (0.14–64.19%). Median increase in resistance assuming laminar and turbulent flow was 16.5% (0.3–680%) and 21% (0.3–1200%), respectively. The most common cause of constriction was the presence of a radiotherapy mouth gag. Significant associations existed between presence of constriction and rostral mispositioning, and caudal mispositioning and extreme brachycephaly. Increased severity of constriction was more likely in smaller ETT. Conclusions and clinical relevanceConstriction and mispositioning of ETT occurred very commonly in this population. Checking the ETT within the oral cavity for constriction and mispositioning is recommended. Radiotherapy mouth gags increase the risk of ETT compression. Smaller ETT are at greater risk of severe constriction. Brachycephalic dogs are at particular risk of caudal mispositioning.