Weight Is More Accurate than Gestational Age When Estimating the Optimal Endotracheal Tube Depth in Neonates.

Hsien-Kuan Liu,Shu-Leei Tey,Pei-Ling Wu,San-Nan Yang,Chien-Yi Wu,Yung-Ning Yang

doi:10.3390/children8050324

Abstract

Determining the optimal endotracheal tube (ETT) depth in neonates remains challenging for neonatologists. The guideline for optimal ETT depth is based on the patients’ weight or gestational age. However, there is a discrepancy in the suggested ETT depth between these two parameters. The aim of this retrospective study was to compare the recommended weight-based and age-based formulas for optimal ETT depth and obtain the optimal reference before intubation. Participants were assigned to group 1 if the recommended ETT insertion depth based on weight was concordant with the recommended depth based on gestational age, and to group 2 if the weight and age-based depth recommendations were discordant. After exclusion, 180 patients were included in the analysis. Results indicated that the predicted ETT depth suggested by age required more adjustment than by weight (p < 0.05). Furthermore, the required adjustment in the weight-based formula was smaller than the age-based formula (p < 0.05). Multivariate linear regression analysis revealed that weight was the key factor affecting the optimal depth (p < 0.001). These results imply that when there is a discrepancy in ETT depth between the weight-based and age-based recommendation, the weight-based one will be more accurate than the age-based one.

Highlights

Predicting the optimal depth of the endotracheal tube (ETT) in intubated neonates remains challenging for neonatologists
We reviewed the records of neonates admitted to the neonatal intensive care unit (NICU) of E-Da Hospital, Kaohsiung, Taiwan, from June 2013 to June 2019
Since 2008, when Kempley et al proposed that gestational age could be used to predict the optimal ETT depth more accurately than weight [7], depth based on either an age or weight formula has been recommended in the 7th Neonatal Resuscitation Program (NRP) [6]

Summary

Introduction

Predicting the optimal depth of the endotracheal tube (ETT) in intubated neonates remains challenging for neonatologists. This measurement is crucial for neonates to achieve adequate respiratory support and for surfactant delivery. A malpositioned ETT can result in adverse outcomes in this vulnerable population. An ETT that is too deep could result in complications such as pneumothorax, desaturation, and lung collapse, while an ETT that is too shallow could lead to accidental extubation [1,2,3]. The difference between the optimal ETT depth and the depth on the first attempt is usually within a range of less than 1 cm. How to correctly place the ETT on the first attempt and minimize later adjustments is a considerable issue for pediatricians

Methods

Results

Discussion

Conclusion