Improving endotracheal tube placement in neonates

Garg, Anip; Sinha, Ajay; Kempley, Stephen

doi:10.1136/archdischild-2018-314982

Cited by 4 publications

(2 citation statements)

References 4 publications

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“…Modified weight-based formulas have not led to improved ETT positions in low birthweight7 and ELBW8 infants. Kempley et al report improved ETT positioning by using a gestational age (GA) table 9 10. In a randomised trial of 90 infants, we found that using gestation did not result in more correctly placed ETT tips than weight 11.…”

Section: Introductionmentioning

confidence: 71%

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

Murphy¹,

Donoghue

O’Donnell

2019

Arch Dis Child Fetal Neonatal Ed

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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.

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Section: Introductionmentioning

confidence: 71%

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

Murphy¹,

Donoghue

O’Donnell

2019

Arch Dis Child Fetal Neonatal Ed

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“…The use of tables with ETT insertion length help clinicians achieve optimal ETT placement. 28,29 Though simulation sessions and training has not been shown to improve rates of successful placement of optimal ETT tip position, 20,30 using aides such as videolaryngoscopy has significantly increased the rates of successful placement of ETT in the optimal position, 31 which is a potential area for further research. Importantly, once the ETT tip is radiologically confirmed to be between T1 and T2, meticulous monitoring of the ETT position at the upper lip during cares and physical examination will help to retain the optimal ETT position and reduce the risk for adverse pulmonary outcomes in this vulnerable group of infants.…”

Section: Discussionmentioning

confidence: 99%

Weight-Based Guide Overestimates Endotracheal Tube Tip Position in Extremely Preterm Infants

2019

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Objective To evaluate the association between endotracheal tube (ETT) tip position and adverse pulmonary outcomes using chest X-ray (CXR) in extremely preterm infants in whom ETT insertion length was estimated using weight + 6 guide (adding 6 cms to the infant’s weight in kg). Study Design CXRs of 85 infants performed in the first week were reviewed for right-sided atelectasis, air leaks, and uneven lung inflation. The first CXR was later reviewed to document the ETT tip. Regression analysis was performed to find the association between ETT tip position and adverse outcome after adjusting for other confounders. Results Forty (46%) infants had ETT tip placement between the first and second thoracic vertebrae (optimal position) compared with 45 (53%) who had the ETT tip placement outside this range (suboptimal position). Infants with suboptimal ETT were ventilated for a longer period (6.1 vs. 15.9 days; p = 0.004). The odds of adverse outcomes was 11.6 (95% confidence interval: 3.03, 44.1) times higher among infants who did not have ETT at the optimal position compared with infants who had ETT at the optimal position. Conclusion Weight + 6 guide is not recommended to estimate ETT insertion length in extremely preterm infants. Gestation-based guide may be more appropriate to estimate ETT insertion length in this group of infants.

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Tip of the Endotracheal Tube: Reassessment of Intubation Procedure in Pediatric and Neonatal Critical Care*

Dong

Sun²

2019

Pediatric Critical Care Medicine

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Improving endotracheal tube placement in neonates

Cited by 4 publications

References 4 publications

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

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

Weight-Based Guide Overestimates Endotracheal Tube Tip Position in Extremely Preterm Infants

Tip of the Endotracheal Tube: Reassessment of Intubation Procedure in Pediatric and Neonatal Critical Care*

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