Utilizing Nasal-Tragus Length to Estimate Optimal Endotracheal Tube Depth for Neonates in Taiwan

Wang, Tzuchiang; Kuo, Li-Ling; Lee, Ching‐Yu

doi:10.1007/s12098-010-0278-8

Cited by 18 publications

(14 citation statements)

References 22 publications

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“…Other methods are based on physical markers like NTL, sternal length or head circumference. These may be faster and more accurate to assess the depth of ETT in neonates (9,22). Because the malposition of the ETT can cause serious complications, the rapid determination of tube placement is a very important goal.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a number of rapid point-of-care methods (e.g., clinical signs, exhaled carbon dioxide (CO 2 ) detectors, respiratory function monitors and ultrasound) to confirm the correct tube placement have been developed (3). Nasal-tragus length (NTL) to predict the optimal ETT depth with the formula, NTL plus 1 cm, has been suggested as clinically practical for newborn infants (9). In our country, NTL is currently used under the Neonatal Resuscitation Program (NRP) recommendations (10).…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Endotracheal Tube Position After Oral Intubation in Neonates

Gül¹,

Takçı²,

Ince³

et al. 2018

jpr

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Endotracheal intubation is a common procedure in the delivery room and neonatal intensive care unit. We aimed to determine the accuracy of this method of endotracheal tube (ETT) placement in our neonatal cohort. Materials and Methods: Data on infants requiring oral intubation were reviewed retrospectively. The initial ETT depth of insertion had been calculated using the Tochen 7-8-9 rule. The initial depth was compared to the mid-tracheal region. The differences between the initial and ideal depth was calculated and divided by the mid-tracheal distance. Infants were grouped according to their weights as ≤1000 g, 1001 to 2000 g, 2001 to 3000 g and ≥3001 g. Results: We evaluated ETT placement in 160 neonates. The mean gestational age was 32.2±4.4 weeks (23 to 41 weeks) and the mean weight was 1989±829 g (560 to 3800 g). The mean range of the difference between the initial depth and ideal depth divided by mid-tracheal distance was 0.39±0.04, 0.35±0.04, 0.46±0.05, and 0.23±0.04 in infants weighing ≤1000 g, 1001 to 2000 g, 2001 to 3000 g and ≥3001 g respectively (p=0.025). The differences between the 2001-3000 g group and the 1001-2000, also the 2001-3000 g group and the ≥3001 g group were statistically significant (p<0.05). Conclusion: The 7-8-9 rule should be used to assess ETT length in neonates, especially in those weighing more than 3 kg. As this rule has low accuracy for extremely low birth weight neonates, its reliability may not be high for neonates weighing less than 3 kg in weight.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Endotracheal Tube Position After Oral Intubation in Neonates

Gül¹,

Takçı²,

Ince³

et al. 2018

jpr

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“…Malposition of endotracheal tubes has been reported to occur in up to 50% of intubation episodes. [11][12][13] Historically, endotracheal tube position has been confirmed radiologically. Some previous studies suggested that the first thoracic vertebral body was a better marker on chest roentgenogram.…”

Section: Introductionmentioning

confidence: 99%

“…The initial clinical assessment of the appropriate intubation depth is to auscultate equal air-entry to the bilateral lungs. 10,12 Nevertheless, it lacks a quantitative or qualitative change of breathing sound detected on auscultation, despite 1cm downward displacement of the ET tube tip into the main bronchus; one study indicated that up to 60% of endobronchial intubations were by equal breath sound auscultation. 15,21 Thus, several methods have been reported to determine the proper ET tube depth for intubation and the accurate ET tube tip position, such as the well-known 7-8-9 Rule, body parameters as a predictor, the manufacturer's markings on the tube tip and sonogram.…”

Section: Introductionmentioning

confidence: 99%

Estimation of length of endotracheal tube insertion by foot length in newborns

Hannan

Prema

Surabhi

2018

Int J Contemp Pediatr

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Background: Intubation is a common procedure for neonates. This study was designed to determine whether the foot length (FL) can predict the depth of endotracheal (ET) tube insertion in newborns.Methods: This one year prospective cross-sectional study was done on 50 neonates admitted to NICU under the Department of Paediatrics, Rajarajeswari Medical College and Hospital, Bangalore from January 2016 to June 2017. The FL was measured and compared with the optimal depth of ET tube insertion. The data was analysed using SPSS version 20.0.Results: The mean FL was 7.42±0.75cms and mean optimal ET tube length was 7.70±0.71cm. The correlation between optimal ET tube length and foot length was noted in 70% of the babies and significant strong positive correlation was noted between optimal ET tube length and FL (r=0.780; p<0.001; R2=0.607). Significant differences were noted in mean FL and mean optimal depth of ET tube in term newborns (p=0.013) and those with normal weight (p=0.016).Conclusions: Foot length could be used as a simple and easy predictor in the estimation of endotracheal tube length in newborns.

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“…With the exception of premature gestation-based recommendations, 4 current age-based formulae have long been recognized as inadequate. Newer weight, 5 length, 6 and anthropomorphic alternatives, such us foot length, 7 middle finger length, 8 and tragus to nares length, 9 have all been studied and found to be better alternatives for infants. Many of these studies were retrospective, and almost all excluded any significant anomalies and pathology.…”

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confidence: 99%