Extubation and endotracheal tube exchange using a guidewire sheath in management of difficult pediatric airways.

摘要

We read with interest the recent letter of Sharma et al. (1) regarding sheath of guidewire as an aid to extubation in difficult pediatric airways. It is indeed a useful alternative when the commercially tube changer is not available. In managing difficult pediatric airways, we have also often used this sheath to perform extubation and endotracheal tube (ETT) exchange. We would like to introduce our practice and experience.The length of this sheath is 150 cm. To make airway procedure convenient and decrease the airflow resistance through the sheath, it should be significantly shorten before the use. In children, a length of 55-60 cm is often adequate. Expect for the three-way-connector designed by the Sharma et al., a 15-mm standard connector of size 4 or 4.5 ETT may also be connected to the distal end of the sheath by a female-to-male mode. By the standard connector, the sheath can be attached to many ventilation devices, such as the anesthetic breathing system, oxygen pipeline, jet ventilator, etc.