Estimation of endotracheal tube depth placement in children

Research output: Contribution to journalArticle

Abstract

Introduction: Complications of endouacbeal intubation, such as endobronchial intubation with resultant hypoxia. are common in children in the pet-hospital environment.' Once the correct endotracheal tube (ET) size is selected based on the patient's age or length, methods are suggested for assuring the proper depth of insertion of the ET. A commonly cited approach is to multiply the ET diameter by three to obtain the approximate depth of insertion in centimeters.2 We examined the accuracy of this method for predicting correct depth of ET placement Methods: Fifty-three intubated children ä12 years of age were studied prospectively. The ET size and depth of placement were chosen for each patient independent of the study. The age (yrs) and length (cm) of each patient and the size (mm) and depth (cm) of the ET were recorded. Chest x-rays were obtained on all patients using standard methods to minimize magnification and were read independently by a radiologist Correct ET placement was defined as having the ET tip below the thoracic inlet and at least 1 cm above the canna. We determined a calculated depth of insertion (GDI) by multiplying the age-based ({16 + age in years}/-) or length-based (Broselow" tape) ET size by three. Using the chest x-ray, this COI was compared to the actual depth of insertion to determine if the GDI would provide correct ET placement Results: Of the 53 patients studied, 36 (68%) were found to have a correctly placed ET on initial chest x-ray. If age-based ET sizes were used for the GDI, 29 of 53 (57%) would have been correctly positioned. In comparison, if length-based ET sizes were used for the GDI. 42 of 53 (81%) would have been correctly positioned. (p< 05) Concluions: Using length-based ET size to determine the CDI provides a method that is 81% accurate in the population studied. However, this accuracy was significantly decreased if age-based ET sizes were used for the CDI. The observed 19% failure rate of the more optimal, length-based CDI suggests that alternative methods for estimating ET depth placement should be developed for use in the prehospital setting. 1 Ann Surg 1990.211 :PALS textbook.

Original languageEnglish (US)
Pages (from-to)A58
JournalCritical care medicine
Volume26
Issue number1 SUPPL.
StatePublished - Dec 1 1998

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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