Endotracheal Tube Position in Neonates Requiring Emergency Interhospital Transfer

ABSTRACT

A malpositioned endotracheal tube (ETT) is common following initial intubation. This study assessed ETT position in 53 orotracheally intubated neonates referred for interhospital transfer during a 3-month period. Position of the ETT on first chest radiograph (CXR) after intubation was assessed and related to radiographic lung expansion, with ducumentation that the final ETT length had achieved a satisfactory position. At the time of first CXR, median ETT length at the lips was 7.0 cm (range, 5 to 12 cm) with median tip position at T3.0 (range, C7 to T6). The ETT required repositioning in 58% of patients. Most malpositioned tubes were too low (26 were withdrawn and only four were advanced; p < 0.001), with lung expansion more closely related to vertebral than clavicular position of the ETT. Final ETT length correlated well with corrected gestation (r = 0.83; p < 0.01) and marginally less well with weight (r = 0.79; p < 0.01). From the regression analysis, we provide a table of recommended tube lengths by gestation.

Infant - newborn - endotracheal intubation - resuscitation - trachea - Bronchus

REFERENCES

• 1 Heinonen J, Takki S, Tammisto T. The effect of the Trendelenberg tilt and other procedures on the position of endotracheal tubes.  Lancet. 1969;  1 850-853
• 2 Hamilton W, Stevens W. Malpositioning of endotracheal catheters.  JAMA. 1966;  198 1113
• 3 Kuhns L R, Poznanski A K. Endotracheal tube position in the infant.  J Pediatr. 1971;  78 991-996
• 4 Bedarek F J, Kuhns L R. Endotracheal placement in infants determined by suprasternal palpation-a new technique.  Pediatrics. 1975;  56 224-229
• 5 Joshi V V, Mandavia S G, Stern L, Wigglesworth F. Acute lesions induced by endotracheal intubation.  Am J Dis Child. 1972;  124 646-649
• 6 Macmillan D D, Rademaker A W. Benefits of orotracheal and nasotracheal intubation in neonates requiring ventilatory assistance.  Pediatrics. 1986;  77 39-44
• 7 Blayney M P, Logan D R. First Thoracic vertebral body as reference for endotracheal tube placement.  Arch Dis Child. 1994;  71 F32-F35
• 8 Heller R M. Early experience with illuminated endotracheal tubes in premature and term neonates.  Pediatrics. 1985;  75 664-666
• 9 Embleton N D, Deshpande S A, Scott D et al.. Foot length an accurate predictor of nasotracheal tube in neonates.  Arch Dis Child. 2001;  85 F60-F64
• 10 Scanlon J W. Rapid manoeuvres to determine location of endotracheal tube in newborn infants.  J Pediatr. 1973;  82 1091-1092
• 11 Blayney M, Costelle S, Perlman M et al.. A new system for location of endotracheal tube in preterm and term neonates.  Pediatrics. 1991;  87 44-47
• 12 Slovis T L. Endotracheal tubes in neonates: sonographic positioning.  Radiology. 1986;  160 262-263
• 13 Leone T A, Rich W, Finer N N. Neonatal intubation: success of pediatric trainees.  J Pediatr. 2005;  146 638-641
• 14 Shukla H K, Hendricks-Munoz K D, Atakent Y, Rapaport S. Rapid estimation of insertional length of endotracheal intibation in newborn infants.  J Pediatr. 1997;  131 561-564
• 15 Niermeyer S, Kattwinkel J, Van Reempts P et al.. International guidelines for neonatal resuscitation: an excerpt from the guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care: International consensus on science.  Pediatrics. 2000;  106 E29