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 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.

The Oro-Helical Length Accurately Predicts Endotracheal Tube Insertion Depth in Neonates

2018 ◽  
Vol 200 ◽  
pp. 265-269.e2 ◽  
Author(s):  
Dianne Lee ◽  
Patricia C. Mele ◽  
Wei Hou ◽  
Joseph D. Decristofaro ◽  
Echezona T. Maduekwe
Keyword(s):  
Endotracheal Tube ◽  
Tube Insertion ◽  
Insertion Depth

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.

Ideal endotracheal tube insertion depth in neonates with a birthweight less than 750 g

2020 ◽  
Vol 62 (8) ◽  
pp. 932-936 ◽  
Author(s):  
Syusuke Takeuchi ◽  
Junichi Arai ◽  
Motomichi Nagafuji ◽  
Ayako Hinata ◽  
Tae Kamakura ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Tube Insertion ◽  
Insertion Depth

scholarly journals Inflating the endotracheal tube cuff with saline to confirm correct depth using bedside ultrasonography

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 94-98 ◽  
Author(s):  
Mark O. Tessaro ◽  
Alexander C. Arroyo ◽  
Lawrence E. Haines ◽  
Eitan Dickman
Keyword(s):  
Tracheal Intubation ◽  
Endotracheal Tube ◽  
Endotracheal Tube Cuff ◽  
Tube Insertion ◽  
Suprasternal Notch ◽  
Insertion Depth ◽  
Tube Cuff ◽  
Emergency Intubation ◽  
Rapid Technique ◽  
Bedside Ultrasonography

AbstractAlthough bedside ultrasonography can accurately distinguish esophageal from tracheal intubation, it is not used to establish the correct depth of endotracheal tube insertion. As indirect sonographic markers of endotracheal tube insertion depth have proven unreliable, a method for visual verification of correct tube depth would be ideal. We describe the use of saline to inflate the endotracheal cuff to confirm correct endotracheal tube depth (at the level of the suprasternal notch) by bedside ultrasonography during resuscitation. This rapid technique holds promise during emergency intubation.

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