Abstract
Optimal positioning of the endotracheal tube (ETT) during mechanical ventilation of the newborn is essential to avoid extubation or inadvertent right or left main stem bronchial intubation. Using a new prototype fiberoptic bronchoscope (FOB)(O.D. 1.8mm) we examined ETT position in 34 infants (birthweight 715g-3500g, gestational ages 26-42 weeks). The tracheal length (TL), defined by distance from vocal cords to carina, was measured in neutral (N), flexion (F), and extension (E) head positions. ETT movements in right lateral (RL), left lateral (LL), F, and E positions were also measured. In. infants <1750g mean TL in the N position was 3.9cm (range 3.4-4.6cm), and mean TL was 5.2cm (range 4.3-8.4cm) in infants >1750g. Relative to the N position, the ETT moved maximally 3.5cm cephalad with E, and 1.8cm caudad with F. Corresponding TL changes were +3.lcm (+62% of TL in N position) with E and -0.9cm (-16% of TL in N position) with F. We concluded: due to small TL in infants <1750g any significant movement of the head can lead to significant tube malposition; TL significantly increases with extension of the head and therefore some of the ETT movement is apparent rather than real; since TL changes with head position, previous recommendations relating ETT position to weight and/or body length are clinically unreliable. We recommend ETT position be checked by chest x-ray or FOB, with the head flexed and be 0.5cm above the carina.
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Woodall, D., Whitfield, J., Grunstein, M. et al. 1741 NEW RECOMMENDATIONS FOR ENDOTRACHEAL TUBE POSITIONING IN THE NEWBORN INFANT. Pediatr Res 15 (Suppl 4), 733 (1981). https://doi.org/10.1203/00006450-198104001-01760
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DOI: https://doi.org/10.1203/00006450-198104001-01760
