scholarly journals Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial

BMJ ◽  
2010 ◽  
Vol 341 (nov09 1) ◽  
pp. c5943-c5943 ◽  
Author(s):  
C. Sitzwohl ◽  
A. Langheinrich ◽  
A. Schober ◽  
P. Krafft ◽  
D. I. Sessler ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Randomised Trial ◽  
Insertion Depth ◽  
Endobronchial Intubation

Randomised trial of estimating oral endotracheal tube insertion depth in newborns using suprasternal palpation of the tip or weight

2019 ◽  
Vol 105 (2) ◽  
pp. 196-200
Author(s):  
Madeleine C Murphy ◽  
Veronica B Donoghue ◽  
Colm Patrick Finbarr O’Donnell
Keyword(s):  
Endotracheal Tube ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Newborn Infants ◽  
Maternity Hospital ◽  
Thoracic Vertebra ◽  
Suprasternal Notch ◽  
Insertion Depth ◽  
Lower Border

BackgroundEndotracheal tube (ETT) tip position is determined on chest X-ray (CXR) and should lie between the upper border of the first thoracic vertebra (T1) and the lower border of second thoracic vertebra (T2). Infant weight is commonly used to estimate how far the ETT should be inserted but frequently results in malpositioned ETT tips. Palpation of the ETT tip at the suprasternal notch has been recommended as an alternative.ObjectiveTo determine whether estimating ETT insertion depth using suprasternal palpation of the ETT tip rather than weight results in more correctly positioned ETT tips.DesignSingle-centre randomised controlled trial.SettingLevel III neonatal intensive care unit (NICU) at a university maternity hospital.PatientsNewborn infants without congenital anomalies intubated in the NICU.InterventionsParticipants were randomised to have ETT insertion depth estimated using palpation of the ETT tip at the suprasternal notch or weight [insertion depth (cm)=6 + wt (kg)].Main outcome measureCorrect ETT position, that is, between the upper border of T1 and lower border of T2 on CXR, determined by one consultant paediatric radiologist masked to group assignment.ResultsThere was no difference in the proportion of correctly placed ETT tips between the groups (suprasternal palpation 27/58 (47%) vs weight 23/60 (38%), p=0.456). Most incorrectly positioned ETTs were too low (56/68 (82%)).ConclusionEstimating ETT insertion depth using suprasternal palpation did not result in more correctly positioned ETTs.Trial registration numberISRCTN13570106.

Randomised trial of estimating oral endotracheal tube insertion depth in newborns using weight or vocal cord guide

2017 ◽  
Vol 103 (4) ◽  
pp. F312-F316 ◽  
Author(s):  
Irwin Gill ◽  
Aisling Stafford ◽  
Madeleine C Murphy ◽  
Aisling R Geoghegan ◽  
Miranda Crealey ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Vocal Cord ◽  
Neonatal Intensive Care ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Newborn Infants ◽  
Maternity Hospital ◽  
Thoracic Vertebra ◽  
Insertion Depth ◽  
Randomised Controlled

BackgroundWhen intubating newborns, clinicians aim to position the endotracheal tube (ETT) tip in the midtrachea. The depth to which ETTs should be inserted is often estimated using the infant’s weight. ETTs are frequently incorrectly positioned in newborns, most often inserted too far. Using the vocal cord guide (a mark at the distal end of the ETT) to guide insertion depth has been recommended.ObjectiveTo determine whether estimating ETT insertion depth using the vocal cord guide rather than weight results in more correctly positioned ETT tips.DesignSingle-centre randomised controlled trial.SettingLevel III neonatal intensive care unit (NICU) at a university maternity hospital (National Maternity Hospital, Dublin, Ireland).PatientsNewborn infants without congenital anomalies intubated in the NICU.InterventionsParticipants were randomised to have ETT insertion depth estimated using weight [insertion depth (cm) = weight (kg) +6] or vocal cord guide.Main outcome measureCorrect ETT position, that is, tip between the upper border of the first thoracic vertebra (T1) and the lower border of the second thoracic vertebra (T2) on a chest X-ray as determined by one paediatric radiologist masked to group assignment.Results136 participants were randomised. The proportion of correctly positioned ETTs was similar in both groups (weight 30/69 (44%) vs vocal cord guide 27/67 (40%), p=0.731). Most incorrectly positioned ETT (69/79, 87%) were too low.ConclusionEstimating ETT insertion depth using the vocal cord guide did not result in more correctly positioned ETT tips.Trial registration numberISRCTN39654846.

Estimating the Endotracheal Tube Insertion Depth in Newborns Using Weight or Gestation: A Randomised Trial

Neonatology ◽  
2015 ◽  
Vol 107 (3) ◽  
pp. 167-172 ◽  
Author(s):  
Aisling M. Flinn ◽  
Colm P. Travers ◽  
Eoghan E. Laffan ◽  
Colm P.F. O''Donnell
Keyword(s):  
Endotracheal Tube ◽  
Randomised Trial ◽  
Tube Insertion ◽  
Insertion Depth

scholarly journals Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy

2021 ◽  
pp. 014556132098051
Author(s):  
Matula Tareerath ◽  
Peerachatra Mangmeesri
Keyword(s):  
Body Mass Index ◽  
Endotracheal Tube ◽  
Body Mass ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
The Body ◽  
Insertion Depth ◽  
Endotracheal Tubes ◽  
Endotracheal Tube Size ◽  
Actual Size

Objectives: To retrospectively investigate the reliability of the age-based formula, year/4 + 3.5 mm in predicting size and year/2 + 12 cm in predicting insertion depth of preformed endotracheal tubes in children and correlate these data with the body mass index. Patients and Methods: Patients were classified into 4 groups according to their nutritional status: thinness, normal weight, overweight, and obesity; we then retrospectively compared the actual size of endotracheal tube and insertion depth to the predicting age-based formula and to the respective bend-to-tip distance of the used preformed tubes. Results: Altogether, 300 patients were included. The actual endotracheal tube size corresponded with the Motoyama formula (64.7%, 90% CI: 60.0-69.1), except for thin patients, where the calculated size was too large (0.5 mm). The insertion depth could be predicted within the range of the bend-to-tip distance and age-based formula in 85.0% (90% CI: 81.3-88.0) of patients. Conclusion: Prediction of the size of cuffed preformed endotracheal tubes using the formula of Motoyama was accurate in most patients, except in thin patients (body mass index < −2 SD). The insertion depth of the tubes was mostly in the range of the age-based-formula to the bend-to-tip distance.

Oscilloscopic Monitoring To Determine Endotracheal Tube Position

PEDIATRICS ◽  
1975 ◽  
Vol 56 (5) ◽  
pp. 824-826
Author(s):  
Michael A. Nelson ◽  
Gerald B. Merenstein
Keyword(s):  
Early Detection ◽  
Endotracheal Tube ◽  
Sine Wave ◽  
Rapid Diagnosis ◽  
Endobronchial Intubation ◽  
Endotracheal Tubes ◽  
Ventilatory Assist ◽  
Tube Position

Observation of oscilloscopic respiratory sine wave with ventilatory assist permits rapid diagnosis and correction of endobronchial intubation. Continuous oscilloscopic monitoring will permit early detection of extubation or malposition of endotracheal tubes.

Comprehensive Overview of Pediatric Airway Management

2019 ◽  
Author(s):  
Dale Woolridge ◽  
Lisa Goldberg ◽  
Garrett S. Pacheco
Keyword(s):  
Airway Management ◽  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Emergency Physician ◽  
Laryngeal Mask ◽  
Volume Control ◽  
Comprehensive Overview ◽  
Insertion Depth ◽  
Pediatric Airway ◽  
Core Skill

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

Comprehensive Overview of Pediatric Airway Management

2019 ◽  
Author(s):  
Dale Woolridge ◽  
Lisa Goldberg ◽  
Garrett S. Pacheco
Keyword(s):  
Airway Management ◽  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Emergency Physician ◽  
Laryngeal Mask ◽  
Volume Control ◽  
Comprehensive Overview ◽  
Insertion Depth ◽  
Pediatric Airway ◽  
Core Skill

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

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