Appropriate Placement Of Endotracheal Tubes In Pediatric Cardiac Patients

Abstract

AIM To evaluate the appropriateness of intubation depth marks on the pediatric tracheal tube as a method of achieving midtracheal tube placement.To review other methods used for correct depth placement of endotracheal tube (ETT). METHODS This is a prospective study carried out at Innova childrens heart hospital Hyderabad India between June 1st to September 30th 2010. One hundred patients with body weight of 10kg and below who had elective cardiac surgeries under general anesthesia were included in the study. Demographic data were obtained from patientscase file. Data concerning type of operation done, ETT (uncuffed polyvinyl chloride tube) size, position, adjustment, type of endotracheal intubation and level of carina were observed. The tube was placed with the recommended centimeter marking aligned with the vocal cords. Radiological examination was carried out in the surgical intensive care unit immediate post operation and after 24hrs with the head in neutral, flexed and extended positions. RESULT The patients were between the ages of 23 days and 4years. They were 58 males and 42 females. The mean body weight of patients was 6.2 ± 2.0kg and height 68.2 ± 10.6cm. The sizes of ETT used were 4.0 (n=37), 4.5 (n=44), and 5.0 (n=9). In 76% of cases the ETT was located at first thoracic vertebra (T1) and in 6% of patients ETT was adjusted to T1. No case of endobronchial intubation or accidental extubation was recorded. CONCLUSION Midtrachea ETT placement was achieved by using intubation depth marks on the pediatric tracheal tube.