Acute and Critical Care

Original Articles

The Carina as a Landmark for Evaluation of Adequate Central Catheter Tip Position with Computerized Tomography: Il Woo Shin, Mi Young Park, Ju Young Choi, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2006;21(1):37-41.

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Abstract PDF: BACKGROUND
The aim of this study was to determine whether the carina can be used as a landmark for evaluation of adequate central catheter tip position, and to examine the relationship between easily measurable body size and variable anatomical parameter.
METHODS
The SVC dimensions and relationship to radiographic landmarks were retrospectively determined from computerized tomography (CT) scans of 200 patients. The CT findings were assessed in terms of SVC length (SVCL), the distance between the carina and the right atrium inlet (CAL), and the sternal length (STL). Pearson's correlation and a regression test for height versus SVCL, STL versus SVCL and CAL were performed.
RESULTS
The median length of the SVC was 4.2 cm (range; 1.6 to 7.2 cm) and the distance between the carina and the right atrium inlet was 2.4 cm (range; 0.8 to 5.6 cm). With the regression test, height was correlated with SVCL (r(2)=0.09), and STL was correlated with both SVCL (r(2)=0.12) and STL (r(2)=0.04).
CONCLUSIONS
The carina was located always above the right atrium inlet. The carina was a reliable, simple anatomical landmark for the determination of correct placement with computerized tomography.

Evaluation of the Technique of Central Venous Catheterization via the External Jugular Vein: Seong Hoon Ko, Dong Chan Kim, Sang Kyi Lee, He Sun Song; Korean J Crit Care Med. 1999;14(2):143-147.

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Abstract PDF: BACKGOUND: This study was designed to evaluate the effectiveness and feasibility of central venous catheterization via the external jugular vein (EJV). We compared the success rate of left and right EJV catheterization. The influence of the course of left and right external jugular vein on success rate was investigated also.
METHODS
Eighty anesthetized adult surgical patients were studied consecutively. Patients were allocated to left or right EJV catheterization and measured the angles between EJV and clavicle and transverse shoulder line. Catheterization was performed under sterile conditions by Seldinger technique after angiography of EJV and subclavian vein. We analyzed the relationship between the angles and success rate and time for catheterization. We compared the success rate of left and right EJV catheterization.
RESULTS
The overall rate of intrathoracic placement was 74 from 80 catheterization (92.5%). Analysis of success in left and right EJV catheterization did not reveal statistically significant differences. The success rates did not show any correlation with course of EJV. Complications were few and not serious.
CONCLUSIONS
This study indicated that left and right EJVs were good routes for central venous catheterizationan with acceptably high success rate. However, we could not find the predictor of success for central venous catheterization via EJV.

Reliable Verification of Endotracheal Tube Location by Pilot Balloon Compression Technique of Tracheal Tube: Sang Kyi Lee; Korean J Crit Care Med. 1998;13(2):218-223.

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Abstract PDF: BACKGOUND: Correct placement of an endotacheal tube (ETT) is crucial, and an ideal test for confirmation of proper ETT placement should be simple and quick to perform, reliable, safe, inexpensive, and repeatable. Palpation of the ETT cuff at the suprasternal notch has been used by clinicians for many years, however the effectiveness of the technique has never been documented. So the author evaluated an efficacy of the pilot balloon compression technique to verify the correct location of an ETT.
METHODS
After anesthetic induction and confirmation of orotracheal intubation, the patient's head is placed in a neutral position. The ETT is withdrawn or advanced while gentle, repeated pressure is applied with the fingers at the pilot balloon. Simultaneously, the suprasternal notch is palpated in the other hand. When the cuff maximally distends from the pressure applied at the pilot balloon, the ETT is secured. After securing the ETT, the distances from its tip to the upper incisor and the carina were measured by means of fiberoptic laryngoscopy.
RESULTS
Endobroncheal intubation was noted in three patients (3%). Average distance from the tip of the ETT to upper incisor in men was 23.9 cm (range, 21.7~26.9) and in women 22.5 cm (range, 20.0~26.0). Average distance to the carina in men was 2.6 cm (range, -0.5~5.0) and in women 1.8 cm (range, -0.6~4.4).
CONCLUSIONS
In this study, location of the ETT was not reliably confirmed by the technique. So the technique should need some modification. When maximal sensation of the ETT cuff is palpated 2.4~3.3 cm in men and 3.2~3.7 cm in women above the suprastenal notch, the location of the ETT tip is theoretically reliable. However, the technique should not be used to verify endotracheal intubation itself.

Case Report

Profound Hypothermia and Circulatory Arrest for Adult PDA Surgery: Case report: Seung Hun Baek, Sang Wook Shin, Hae Kyu Kim, Seong Wan Baik, Inn Se Kim, Kyoo Sub Chung; Korean J Crit Care Med. 1997;12(2):187-191.

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Abstract PDF: Correction of a calcified patent ductus arteriosus (PDA) is a difficult surgical procedure. Simple ligation or division of PDA is not possible if diffuse circumferential calcification is present. Several techniques using cardiopulmonary bypass and closure of PDA from within the aorta or pulmonary artery have been introduced. And the surgical procedure is performed under profound hypothermia and circulatory arrest. Total ischemia time should be less than 30 minutes, which is free from the organ damage by the circulatory arrest. Barbiturates, calcium channel blockers and steroids are used for brain protection. We experienced successful use of these techniques for adult female patch closure of PDA and reviewed the anesthetic considerations of the profound hypothermia and circulatory arrest for cardiac surgery.

Original Article

An Anthropometric Measurements of the Upper Airway Using Fiberoptic Laryngoscope in Korean Adults: Sang Kyi Lee, Chun Won Yoo; Korean J Crit Care Med. 1997;12(2):143-150.

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Abstract PDF: Introduction: An anthropometric distance is crucial for an easy endotracheal intubation and correct placement of endotracheal tube in the trachea. There may be a racial difference of the anthropometric measurement. So we measured the anthropometric distances of the upper airway in Korean adult patients.
METHODS
A standard anesthetic induction and maintenance was performed in 100 adult patients following endotracheal intubation. Various anthropometric measurements were determined while the patients head were in a neutral position. Thyromental and sternomental distance were measured. A distance from upper central incisor to carina or cricoid cartilage was directly measured using fiberoptic laryngoscope. However, the length from upper central incisor to midtrachea & the cricoid cartilage-carina distance were indirectly calculated from the above measured distances. Correlation analyses were also performed between age, height, or weight and the above measured anthropometric distances.
RESULTS
The mean distances from upper central incisor to carina, cricoid cartilage or midtrachea were 25.5+/-1.8, 13.9+/-1.9, or 19.8+/-1.8cm respectively. The mean distance from cricoid cartilage to carina was 11.6+/-1.4cm. Thyromental and thyrosternal distance were 6.6+/-0.9 and 15.7+/-1.5cm respectively. All mean anthropometric distances of male were longer than those of female patients. Thirty-eight patients (38%) had the thyromental distance < or = 6cm while one patient (1%) had thyrosternal distance < or = 12.5cm. A good correlation (r< or =0.6) was observed between height and upper central incisor-carina distance.
CONCLUSIONS
This study suggests that these measured anthropometric data are useful for an easy endotracheal intubation and accurate endotracheal placement in the trachea.

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