Parker Flex-Tip and Standard-Tip Endotracheal Tubes: A Comparison During Nasotracheal Intubation
The placement of endotracheal tubes in the airway, particularly through the nose, can cause trauma. Their design might be an important etiologic factor, but they have changed little since their introduction. Recently Parker Medical (Bridgewater, Conn ) introduced the Parker Flex-Tip (PFT) tube, suggesting that it causes less trauma. This study aimed to compare the PFT endotracheal tube to a side-beveled, standard-tip endotracheal tube (ETT) for nasotracheal intubation (Figures 1 and 2). Forty consecutive oral surgery patients requiring nasotracheal intubation were randomized to receive either a standard ETT or the PFT tube. Intubations were recorded using a fiber-optic camera positioned proximal to the Murphy eye of the tube. This allowed visualization of the path and action of the tube tip as it traversed the nasal, pharyngeal, laryngeal, and tracheal airway regions. Video recordings made during intubation and extubation were evaluated for bleeding, trauma, and intubation time. Both bleeding and trauma were recorded using a visual analogue scale (VAS) and by 3 different evaluators. The PFT received significantly better VAS values than the standard tubes from all 3 raters (P < 0.05) in both the extent of trauma and bleeding. Since the intubations were purposefully conducted slowly for photographic reasons, neither tube displayed a time advantage. This study suggests that the PFT tube design may be safer by causing less trauma and bleeding than standard tube designs for nasotracheal intubation.Abstract

Standard (below) versus Parker (above) from side view.

Standard (below) versus Parker (above) from above view.

Fiber-optic placement within tube.

Comparison of means: study population parameters.

Mean comparisons of visual analogue scale (VAS) data in response to bleeding. 0 = standard tube; 1 = Parker tube. Graph indicates 95% confidence intervals with no overlap of means interpreted as a significant difference in the means.

Mean comparisons of visual analogue scale (VAS) data in response to trauma. 0 = standard tube; 1 = Parker tube. Graph indicates 95% confidence intervals with no overlap of means being interpreted as a significant difference in the means.

Comparison of means: intubation times.

Comparison of means: bleeding and trauma.

The calculated probability that the reduced bleeding observed in this study using tube 1 was a chance occurrence is less than P = .0001. Grey = probability of no bleeding. Tube 0 = standard tube. Tube 1 = Parker tube.

The calculated probability that the reduced trauma observed in this study using Tube 1 was a chance occurrence is less than P = .007. Grey = probability of no trauma. Tube 0 = standard tube. Tube 1 = Parker tube.
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