Abstract
BackgroundRecommendations for endotracheal tube (ETT) size usually refer to the inner diameter (ID). Outer diameters (OD), however, vary greatly between manufacturers, which in some brands might cause difficulties in passing the ETT through the nostrils if choosing the nasal route for intubation. Even though the nostrils are dilatable by an ETT, it might be difficult to pass an ETT through the posterior naris (narrowest point of the nasal passage), if the OD is bigger than the nostrils. Therefore, nostril size may provide some guidance for the appropriate ETT size preventing unsuccessful intubation attempts. This study therefore compares nostril sizes of newborn infants with ODs of ETTs from several manufacturers.MethodsThis is a subgroup analysis of a prospective observational study, performed in a single tertiary perinatal centre in Germany. The diameter of the nostril of infants born between 34 and 41 weeks´ gestation was measured in 3D images using 3dMDvultus software and compared to the OD of ETT from five different manufacturers.ResultsComparisons of nostril sizes with ODs of different ETTs were made for 99 infants with a mean (SD) birthweight of 3058g (559) [range: 1850-4100g]. Mean (SD) nostril size was 5.3mm (0.6). The OD of the 3.5mm ETT of different manufacturers ranged from 4.8-5.3mm and was thus larger than the nostril size of 20-46% of late preterm or term infants.Some OD of a 3.0mm ETT were even bigger than the OD of a 3.5mm ETT (e.g. the 3.0mm ETT from Rüsch® has an OD of 5.0mm while the 3.5mm ETT from Portex® has an OD of 4.8mm).ConclusionsClinicians should be aware of the OD of ETTs to reduce unsuccessful intubation attempts caused by ETT sizes not fitting the nasal cavity. Generated data may help to adapt recommendations in future.Trial registrationSubgroup analysis of the “Fitting of Commonly Available Face Masks for Late Preterm and Term Infants (CAFF)”-study: NCT03369028, www.ClinicalTrials.gov, December 11, 2017.
Highlights
Recommendations for endotracheal tube (ETT) size usually refer to the inner diameter (ID)
We compared the Outer diameters (OD) of 3.5mm ETTs with the nostril size of each infant in line with the European Resuscitation Council (ERC) guidelines [7]
In accordance with the International Liaison Committee on Resuscitation (ILCOR) statement from 1999 [12], the population was divided into two groups and the nostril size of each infant with a birthweight
Summary
Recommendations for endotracheal tube (ETT) size usually refer to the inner diameter (ID). This study compares nostril sizes of newborn infants with ODs of ETTs from several manufacturers. The statement from the International Liaison Committee on Resuscitation (ILCOR) from 1999 is imprecise [12], as it recommends a 3.0 or 3.5 mm ETT for infants weighing between 2000-3000g, and a 3.5 or 4.0mm for those weighing ≥3000g [12]. It remains unclear on which evidence these recommendations are based
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