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

Abstract

ISRCTN39654846.

Distances from vocal cords to mid‐trachea for optimizing endotracheal tubes depth markers according to gestational age

“…Conversely, a 26 mm marking on 3.5 mm ETT represent an adequate distance only for term infants, and will be too long for moderately preterm newborns. This is in keeping with the results of Gill et al RCT comparing intubation according to depth marker or weight based formula where 49% of the preterm infants in the depth marker group had their ETT inserted too distally.…”

“…Multiple depth markers on ETT should be compared to commonly used patterns before being implemented. Another important comparison would be with other methods of assessment, such as formula, suprasternal palpation, and sonography . End‐points for clinical trials should not be limited to radiological position but would need to include procedural and respiratory adverse events.…”

“…Aiming for the black line is advocated in neonatal resuscitation teaching, and is widely accepted as an adequate method for optimizing ETT position . However, use of the depth marker rather than a weight based formula was associated, in a randomized controlled trial of intubation in preterm infants, with similarly low (40%) rate of satisfactory uncuffed ETT positions …”

“…1 However, use of the depth marker rather than a weight based formula was associated, in a randomized controlled trial of intubation in preterm infants, with similarly low (40%) rate of satisfactory uncuffed ETT positions. 5 Over the years, the depth markers have clearly evolved in a nonharmonized way. Distances from ETT tip to marker line vary considerably between brands and even between tubes from the same company: Distances ranging from 15 to 28 mm were reported in uncuffed 2.5 mm ETT.…”

Improving endotracheal tube placement in neonates

“…It was good to read Gill et al ’s1 report on a carefully conducted randomised trial examining methods to estimate endotracheal tube (ETT) length. Together with their group’s previous trial,2 neither use of the vocal cord guide nor a gestation-based formula showed superiority over the traditional 7-8-9 rule (Tochen’s formula).…”