NIM TriVantage™ electromyogram endotracheal tube kinking and the preclusion using a tube stand in patients undergoing thyroid surgery
Kensuke Suzuki, Shingo Kawashima, Atsushi Kobayashi, Tetsuro Kimura, Yoshiki Nakajima, Hiroyuki KinoshitaABSTRACT
Background:
The NIM TriVantage™ electromyogram endotracheal tube (NIM [Nerve Integrity Monitoring] tube) is positioned at the midline of the mouth, as the electrodes must attach to both sides of the vocal cords for neural monitoring during thyroid surgery. The tube possibly kinks below the slip joint, resulting in ventilatory disturbance. We examined whether kinking of the NIM tube altered ventilation in a simulation model and assessed whether using a tube stand during thyroid surgery prevented such kinking and associated ventilatory instability.
Methods:
We assessed the impact of bending warmed (32°C) NIM tubes (7.0- and 8.0-mm ID,
Results:
In a simulator, 75° bending of the NIM (7.0 mm) tube significantly augmented airway pressure (31 [28 to 34] cmH
2
O, median [IQR],
Conclusions:
The NIM (7.0 mm) tube is vulnerable to kinking-induced ventilatory impairment in the clinical setting, and a tube stand prevents this issue. We recommend using a tube stand during thyroid surgery to ensure safe and effective neural monitoring.