ETT and neck movement

Q: Extension of neck (Chin up) will cause Endotracheal tube (ETT) to migrate? - Select one

A) up 

B) down

Answer: A

Extending the neck (Chin up) causes ETT to migrate up, and flexion of the neck (Chin down) causes ETT to migrate down.

Rule:

Chin up - ETT up

Chin down - ETT down

Clinical application: During tracheostomy, operator has to extend the neck. This may inadvertently extubate the patient prior to insertion of tracheostomy tube. 

#procedures

#ENT

References:

1. Tsukamoto M, Yamanaka H, Hitosugi T, Yokoyama T. Endotracheal Tube Migration Associated With Extension During Tracheotomy. Anesth Prog. 2020 Spring;67(1):3-8. doi: 10.2344/anpr-66-04-05. PMID: 32191508; PMCID: PMC7083118.

2. Kim JT, Kim HJ, Ahn W, Kim HS, Bahk JH, Lee SC, Kim CS, Kim SD. Head rotation, flexion, and extension alter endotracheal tube position in adults and children. Can J Anaesth. 2009 Oct;56(10):751-6. doi: 10.1007/s12630-009-9158-y. Epub 2009 Jul 29. PMID: 19639372.