Reexamining the ideal depth of endotracheal tube in neonates

Chung, Hao‐Wei; Lee, Wei-Te; Chen, Hsiu-Lin

doi:10.1016/j.pedneo.2017.10.001

Cited by 10 publications

(13 citation statements)

References 22 publications

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“…In line with previous studies, we found the predicted OTDs using TF were in concordance with the ideal ETT positions in over 50% of our ELBW infants and EP infants (9,14). The estimated OTDs also did not significantly differ from the measured OTDs in the EP, ELBW, and SGA infants, akin to a recent study which reported that the mid-tracheal concordance of TF was not lowered in SGA infants (17). In contrast, the weight-based NRP recommendations were unreliable, and were concordant with the mid-trachea in only 8.3 and 10.7% of the intubated ELBW and EP infants, respectively.…”

Section: Shading Explanationsupporting

confidence: 91%

Comparisons and Refinements of Neonatal Oro-Tracheal Intubation Length Estimation Methods in Taiwanese Neonates

et al. 2020

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This study aimed to evaluate the efficacy of Tochen's formula [TF, body weight (kg) plus 6 cm], nasal septum to ear tragus length (NTL) + 1 cm, and Neonatal Resuscitation Program gestational age (NRP-GA) and body weight (NRP-BW)-based intubation table in estimating the oro-tracheal intubation length, and to improve the estimation efficacy using anthropometric measurements in Taiwanese neonates. Study design: This was a prospective observational study conducted at a neonatal intensive care unit in Taipei, Taiwan. One hundred intubated neonates were enrolled. The estimated intubation depth was defined as being mid-tracheal concordant if it placed the endotracheal tip between the upper border of the first and the lower border of the second thoracic vertebra. A linear regression model was used to analyze the relationships between mid-tracheal depth and body weight (BW), NTL and gestational age (GA), and to revise the NRP intubation tables using our results. Results: Overall, 56% of the neonates were born at a GA ≤ 28 weeks and 48% had a BW ≤ 1,000 g. The overall mid-tracheal concordance rates for TF, NTL + 1 cm, NRP-GA, and NRP-BW estimations were 51.0, 57.0, 15.0, and 14.0%, and in the infants with a BW ≤ 1,000 g 56.3, 56.3, 8.3, and 8.3%, respectively. Our revisions of the NRP intubation tables based on the anthropometric measurements of our participants improved the efficacy of BW, GA, and NTL estimations to 63, 44, and 61%, respectively. Conclusion: TF and NTL + 1 cm were more reliable than NRP intubation tables in predicting the neonatal mid-tracheal length in neonates of all BW and GA. Considering morphological differences secondary to ethnicity, we recommend using these tailored recommendations during neonatal resuscitation in Asian neonates.

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Section: Shading Explanationsupporting

confidence: 91%

Comparisons and Refinements of Neonatal Oro-Tracheal Intubation Length Estimation Methods in Taiwanese Neonates

et al. 2020

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“…In this issue of Pediatrics and Neonatology, the study conducted by Chung et al 5 has retrospectively compared the final ideal ET insertion depth using the Tochen's formula, determined the correlation between neonatal clinical factors and the final ideal ET insertion depth, and devised an accurate predictive formula that can be applied for Taiwanese neonates. They enrolled 139 neonates and found that the final ideal ET insertion depth was in concordance with the Tochen's formula in 19 neonates (13.7%), relatively deeper in 30 (21.6%) neonates, and shallower than the values obtained using the Tochen's formula in 90 (64.7%) neonates.…”

mentioning

confidence: 99%

A new formula for estimating endotracheal tube insertion depth in neonates

Chen

2018

Pediatrics & Neonatology

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“…The optimal ETT depth has been revised over time [ 5 , 6 ], and several studies have re-evaluated the ideal ETT depth using new methods [ 5 , 14 , 15 ]. 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 NRP [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…The other issue worth discussing is the malposition rate in neonates who need intubation. According to previous studies, the prevalence of ETT malposition ranges from 28.9% to 57%, and in 47% of infants <1 kg [ 14 , 15 , 21 ]. The high prevalence of malposition indicated that neonates might be exposed to another dangerous situation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Reexamining the ideal depth of endotracheal tube in neonates

Cited by 10 publications

References 22 publications

Comparisons and Refinements of Neonatal Oro-Tracheal Intubation Length Estimation Methods in Taiwanese Neonates

Comparisons and Refinements of Neonatal Oro-Tracheal Intubation Length Estimation Methods in Taiwanese Neonates

A new formula for estimating endotracheal tube insertion depth in neonates

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

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