Preventing inadvertent Endobronchial intubation: Upper incisor to manubriosternal joint length as a predictor of airway length in children

Jain, Apoorv; Wadhwa, Bharti; Saxena, Kirti N

doi:10.1111/pan.14023

Cited by 3 publications

(2 citation statements)

References 13 publications

(18 reference statements)

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“…An improved tube insertion depth may be achieved by assessing various anatomical distances (e.g., the upper incisor to manubriosternal joint length) prior to intubation [ 30 , 31 , 32 ]. Formula approaches on bedside prediction of adequate tube insertion depth use body weight, body height, tube diameter (e.g., 3× tube size), and the age in years for calculations [ 33 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Tracheal Tube Misplacement after Emergency Intubation in Pediatric Trauma Patients: A Retrospective, Exploratory Study

Rost

Donaubauer

Kirsten³

et al. 2022

Children

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Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management.

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Section: Discussionmentioning

confidence: 99%

Tracheal Tube Misplacement after Emergency Intubation in Pediatric Trauma Patients: A Retrospective, Exploratory Study

Rost

Donaubauer

Kirsten³

et al. 2022

Children

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“…The greatest utility of this technique will be in children who are significantly smaller or larger than children their age in whom standard equations to estimate size under- or over-estimate. One may estimate the depth of tracheal tube insertion in children aged 2–8 years old using the location of the manubriosternal joint, which is also the external landmark for the plane of the tracheal carina [17].…”

Section: Anatomymentioning

confidence: 99%

Pediatric airway management

Hsu

Ungern‐Sternberg

Engelhardt

2021

Current Opinion in Anaesthesiology

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Purpose of reviewChildren are at risk of severe hypoxemia in the perioperative period owing to their unique anatomy and physiology. Safe and effective airway management strategies are therefore key to the practice of pediatric anesthesia. The goal of this review is to highlight recent publications (2019)(2020)(2021) aimed to advance pediatric airway safety and to highlight a proposed simple, pediatric-specific, universal framework to guide clinical practice. Recent findingsRecent investigations demonstrate that infants with normal and difficult airways experience high incidences of multiple laryngoscopy attempts and resulting hypoxemia. Video laryngoscopy may improve tracheal intubation first attempt success rate in infants with normal airways. In infants with difficult airways, standard blade video laryngoscopy is associated with higher first attempt success rates over non-standard blade video laryngoscopy. Recent studies in children with Pierre Robin sequence and mucopolysaccharidoses help guide airway equipment and technique selection. Department airway leads and hospital difficult airway services are necessary to disseminate knowledge, lead quality improvement initiatives, and promote evidence-based practice guidelines.

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Height best predicts the optimal insertion length of orotracheal tubes in children

Ross,

Abou-Zamzam,

Newth

2024

Intensive Care Med. Paediatr. Neonatal

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Introduction Accurate formulae to predict the optimal insertion length of endotracheal tubes (ETT) are necessary for safe care and have been based on height, weight, age, and ETT size. We believe height best reflects the somatic growth of the trachea. Our goal is to compare a formula generated using height for optimal initial insertion length of ETT to previously published formulae based on height, weight, age, and ETT size. Methods We retrospectively reviewed chest radiographs over a two-year period where the head was assured in midline and midposition. We excluded children with conditions altering tracheal dimensions or stature, and scoliosis. We chose 2 cm above the carina to be the optimal insertion length of the ETT which was then correlated to height. We created linear regression equations and Bland-Altman plots. Results Two hundred three orotracheally intubated children were included. The optimal ETT insertion length using the formula Height (cm)/8 + 3.4 had a high association with linear regression and Bland-Altman plots had the narrowest 95% limits of agreement as compared to previously published formulae. Conclusions We found optimal insertion length = Height (cm)/8 + 3.4 is more accurate as compared to commonly used formulae that are based on weight, age, or ETT size. This formula places the ETT 2 cm above the carina which should be safe until a chest radiograph is obtained. We find that the use of formulae that divide the height by 10 overestimates the depth of insertion in younger, smaller children and underestimates the depth of insertion in older children.

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Preventing inadvertent Endobronchial intubation: Upper incisor to manubriosternal joint length as a predictor of airway length in children

Cited by 3 publications

References 13 publications

Tracheal Tube Misplacement after Emergency Intubation in Pediatric Trauma Patients: A Retrospective, Exploratory Study

Tracheal Tube Misplacement after Emergency Intubation in Pediatric Trauma Patients: A Retrospective, Exploratory Study

Pediatric airway management

Height best predicts the optimal insertion length of orotracheal tubes in children

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