1462 Optimal level and bevel position for endotracheal tubes in preterm neonates

Abstract

<h3>Background</h3> Most acceptable endotracheal tube (ET) tip position quoted in literature is between T1 and T2 vertebrae. Currently, there is no standards in term of optimal endotracheal tube bevel position in neonates. <h3>Objectives</h3> Prevalence of right upper lobe collapse/consolidation (RUC) and its association with various ET bevel and level position. <h3>Methods</h3> In this retrospective single center study (level 3 neonatal unit), chest radiographs of ventilated extreme preterm neonates (≤28 weeks) were reviewed for a period of two years (2019 and 2020). Data was collected for ET tip position, bevel position, presence or absence of right upper lobe collapse. Multiple X-rays taken on different days from the same baby were included for the X-ray analysis. We defined sub-optimal ET position when the ET tip is above T1 or at/below T3 vertebrae. In our unit, we used the formula 6 + body weight in kg for fixing ET and always confirmed by chest X-ray. RUC is a discrete common lung pathology in preterm infants and hence used in his study. The project was registered with hospital authorities and approved by the audit department. <h3>Results</h3> 429 X-rays from 104 preterm infants on mechanical ventilation were reviewed. After exclusion 419 X-rays were available for analysis (10: incomplete X-ray information). Mean birth gestational age in weeks and birth weight in grams (± SD) were 25.9 ± 1.7 and 847.5 ± 248 respectively. Number of X-rays with (Sub-optimal) ET tip above T1 and ≥T3 vertebrae were 58 (14%) and 128 (30.5%) respectively. There were 349 (83%) X-rays with ET tip bevel facing left side. There was 57 (13.6%) X-rays with definitive diagnosis of RUC. 21 (37%) cases of RUC occurred despite the optimal ET tube position. Odds ratio and statistics were calculated for RUC with bevel facing left and different ET position were calculated (table 1). <h3>Conclusions</h3> In our study, 44% of ET were in sub-optimal position and commonly fixed with bevel facing left side (83%). RUC is commonly noted (13.6%) discrete lung pathology. Bevel facing left side in the optimal position could play a role in pathogenesis of RUC. Further insight is needed in terms of optimal ET bevel position. RUC could be reduced by placing the ET between T1-T2 (OR: 0.13 (0.003–0.83).