Detection and correction of endotracheal‐tube position in premature neonates

Abstract

Due to the short airways in premature children, an accurate position of the endotracheal tube (ETT) is crucial for adequate mechanical ventilation. Verification of ETT-position is done in chest radiographs. However, ETT-position varies substantially with head movement. When the head is flexed, the tube might appear too deeply inserted, and inadvertent extubation may occur in cases of retraction of ETT after radiography. Extension of the cervical spine will suggest an inappropriately high ETT-position, so that intended corrections can lead to main-stem intubation. Radiographic visible skeletal structures could serve as reference points to allow the detection of head declination and imperfect positioning of ETT. Ratios of anatomical landmarks were used to estimate head position. In this study, 111 radiographs of 24 preterm neonates with a gestational age of 24-29 weeks and weights of 500-1,000 g were analyzed. A mathematical algorithm for the detection and correction of ETT-positions, based on common chest radiographs, was developed. In 108 cases (97.3%), ETT-distance from the midtracheal level was less than 2 mm after use of the proposed correction.Thus, the suggested correction equation for head position enables verification of the actual ETT-position without requiring a defined placement of the head during radiography. Moreover, it can be helpful for estimating the depth of ETT-insertion in conditions when radiography is not available.

Reducing Unplanned Extubations in the NICU Following Implementation of a Standardized Approach

“…Our project supports the benefit of encouraging a safety culture to successfully implement measures aimed at improving best practices. In the setting of current literature, which does not completely define best practices to prevent a UE from occurring, this project importantly defines a standard for head positioning 11 and ETT placement on chest radiograph. The ETT travels greater than 40% of the length of the trachea with head movement when the chin is moved from the full down to full up position as an example of extension or flexion.…”

Optimal Endotracheal Tube Tip Position in Extremely Premature Infants

“…ETT tip below the carina (i.e., in the bronchi) is clearly associated with serious adverse pulmonary outcomes like pneumothorax and right upper lobe collapse; therefore it is recommended that the tip be kept above the carina. [1][2][3] However, the optimal position for the tip is not known. The midpoint of the first thoracic vertebrae (T1) corresponds to the midtracheal point, [4][5][6][7] which is the theoretical argument for keeping the tip at the T1 position.…”

Accuracy and Precision of an Optoacoustic Prototype in Determining Endotracheal Tube Position in Children

“…16,17 If positioned too deeply, ETTs may cause carinal irritation, reactive bronchospasm, or endobronchial intubation, which in turn can impair gas exchange due to under-expansion of the nonventilated lung and overdistention or barotrauma of the ventilated lung. 18 When at the correct depth, the distal tip of the ETT is located in the mid-tracheal region, or halfway between the superior borders of the clavicular heads and the carina, 19 with the proximal end of the ETT cuff below the vocal cords. 20 We used the sternal notch as an easily palpable anatomic landmark that is formed by the heads of the clavicles.…”