Abstract
Background: Accurate determination of the optimal insertion depth of a pediatric endotracheal tube (ETT) is quite important. The aim of this study was to create an easily available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice. Methods: Eighty children under 12 years of age were enrolled. The depth marking of the cuffed ETT was placed at the vocal cords and both lungs were then auscultated using a stethoscope. The upper limit was radiographically defined as the position of the tip of the cuffed ETT being between the clavicles. The lower limit was defined as a distance of 5 mm above the carina. The relationship between the insertion depth and patient characteristics was analyzed to create a formula for optimal ETT insertion depth. Results: Sixty-nine ETTs were optimally placed in the trachea. There were good correlations between the optimal insertion depth of ETTs and patients characteristics (height (R = 0.92); BSA (R = 0.92); weight (R = 0.91); age (R = 0.88)). Using these patient characteristics, we created the following three formulas for calculation of the optimal insertion depth for pediatric cuffed ETTs: insertion depth (cm) = height (cm)/11 + 5.5, weight (kg)/3 + 9.5 or 11 + 3/4 × age (years). The rates of appropriate tube placement of both pediatric cuffed ETTs were 87.5% (Hi-Contour) and 85.0% (Microcuff). Conclusions: Our formula and graphs may be easy to determine the optimal insertion depth of cuffed ETT even without depth marking in clinical practice.
Highlights
Pediatric endotracheal tube (ETT) management is of great concern in anesthesia and intensive care medicine
The aim of this study was to create an available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice
Uncuffed ETTs had been used for several decades [4] and the many reports on the advantages of cuffed ETTs and improvements in the cuffs available had led to the use of cuffed ETTs even in infants and small children [5] [6] [7]
Summary
Pediatric endotracheal tube (ETT) management is of great concern in anesthesia and intensive care medicine. Several methods for prediction of the optimal insertion depth have been reported [9] [10] [11] [12] [13]; none of these reports has clearly defined the upper and lower limits of the tube tip in the trachea. The aim of this study is to create a formula for optimal depth of insertion of a pediatric cuffed ETT that includes both the upper and lower limits for the tube tip in the trachea. The aim of this study was to create an available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice. Conclusions: Our formula and graphs may be easy to determine the optimal insertion depth of cuffed ETT even without depth marking in clinical practice
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