{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:28:23Z","timestamp":1787228903555,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The NIM TriVantage\u2122 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We assessed the impact of bending warmed (32\u00b0C) NIM tubes (7.0- and 8.0-mm ID,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 10 per group) on airway pressure and measured tidal volume within a simulator. Additionally, we investigated whether a custom-designed tube stand could mitigate ventilatory impairment when employing a midline-fixed NIM tube in patients undergoing thyroid surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In a simulator, 75\u00b0 bending of the NIM (7.0 mm) tube significantly augmented airway pressure (31 [28 to 34] cmH\n                      <jats:sub>2<\/jats:sub>\n                      O, median [IQR],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and 60\u00b0 and 75\u00b0 bending of it caused a slight, but significant decrease in the measured tidal volume compared with 0\u00b0 bending. Using our custom tube stand prevented kinking of the 7.0-mm NIM tube, with no clinically meaningful changes in airway pressure or delivered tidal volume during surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sja.sja_324_26","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:00:42Z","timestamp":1782968442000},"page":"632-637","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["NIM TriVantage\u2122 electromyogram endotracheal tube kinking and the preclusion using a tube stand in patients undergoing thyroid surgery"],"prefix":"10.4103","volume":"20","author":[{"given":"Kensuke","family":"Suzuki","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Kawashima","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan"},{"name":"Department of Anesthesiology, Seirei Mikatahara General Hospital, Hamamatsu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan"},{"name":"Department of Anesthesiology, Seirei Mikatahara General Hospital, Hamamatsu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuro","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Nakajima","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan"},{"name":"Department of Anesthesiology, Seirei Mikatahara General Hospital, Hamamatsu, Japan"},{"name":"Department of Dental Anesthesiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"R1-20260820","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/ALN.0000000000004312","article-title":"Intraoperative management of a severely kinked endotracheal tube and difficult airway","volume":"137","author":"Nash","year":"2022","journal-title":"Anesthesiology"},{"key":"R2-20260820","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1213\/01.ane.01000246275.01903.2c","article-title":"Intraoperative kinking of polyvinyl endotracheal tubes","volume":"103","author":"H\u00fcbler","year":"2006","journal-title":"Anesth Analg"},{"key":"R3-20260820","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s12871-017-0432-1","article-title":"Role of tube size and intranasal compression of the nasotracheal tube in respiratory pressure loss during nasotracheal intubation: A laboratory study","volume":"17","author":"Futagawa","year":"2017","journal-title":"BMC Anesthesiol"},{"key":"R4-20260820","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/SAP.0b013e31818a90e2","article-title":"Patient draping and endotracheal tube positioning during facelift surgery","volume":"63","author":"Dobryansky","year":"2009","journal-title":"Ann Plastic Surg"},{"key":"R5-20260820","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/lary.21119","article-title":"Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement","volume":"121","author":"Randolph","year":"2011","journal-title":"Laryngoscope"},{"key":"R6-20260820","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/anae.12608","article-title":"Nerve integrity monitor tubes for thyroid surgery","volume":"69","author":"Medniuk","year":"2014","journal-title":"Anesthesia"},{"key":"R7-20260820","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.anorl.2011.09.003","article-title":"Intraoperative laryngeal nerve monitoring during thyroidectomy and parathyroidectomy: A prospective study","volume":"129","author":"Julien","year":"2012","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"key":"R8-20260820","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1002\/lary.28513","article-title":"Comparison of recording electrode arrays in endotracheal thyroid monitoring tubes in a porcine model","volume":"130","author":"Kandil","year":"2020","journal-title":"Laryngoscope"},{"key":"R9-20260820","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1007\/s00268-008-9483-2","article-title":"Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery","volume":"32","author":"Dralle","year":"2008","journal-title":"World J Surg"},{"key":"R10-20260820","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/ans.12590","article-title":"Consensus statement on intra-operative electrophysiological recurrent laryngeal nerve monitoring during thyroid surgery","volume":"84","author":"Serpell","year":"2014","journal-title":"ANZ J Surg"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_324_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:01:16Z","timestamp":1787227276000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_324_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_324_26","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-04-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}