Use of cut endotracheal tubes should be avoided in the initial resuscitation of the burned patient
- Correspondence to: Dr M A Gillies;
The use of cut endotracheal tubes is already a contentious issue amongst anaesthetists.1 We wish to point out a potentially life threatening hazard when they are used in the emergency department during the initial resuscitation of the thermally injured patient.
Often these patients are intubated early if there is any indication of inhalational injury or facial burns. This is because subsequent oedema of the face and larynx can compromise the airway2 and render intubation difficult or impossible.
If a cut endotracheal tube has been used to secure the airway in this situation and there is subsequent facial or airway swelling, the proximal end of the endotracheal tube may become positioned within the oropharynx making access to it difficult. Worse still, if proximally secured, the distal end may become dislodged from the larynx. At this stage it may be extremely difficult to re-intubate the patient or exchange the tube for a longer one.
As these patients are often transferred to specialist burns units, the consequences of this occurring mid-transfer would be catastrophic.
As a tertiary referral centre for burns we often receive patients directly from emergency departments. It has, in the past, been necessary for us to perform quite hazardous tube changes on these patients.
We now routinely ask that all referring emergency departments ensure that any burns patient intubated with a cut endotracheal tube has it exchanged for an uncut one before transfer and we recommend that uncut endotracheal tubes only are used in the initial resuscitation of the burned patient.