OBJECTIVE: To determine whether multiplying the internal diameter of the endotracheal tube (ETT) by 3 (3x ETT size) is a reliable method for determining correct depth of oral ETT placement in the pediatric population. DESIGN: Prospective, observational. SETTING: University-affiliated, 12-bed pediatric intensive care unit. PATIENTS: Orally intubated pediatric intensive care unit patients of < or =12 yrs of age. INTERVENTIONS: Demographics, ETT size, and depth of ETT placement measured from the lip were obtained. Correct placement, defined as the tip of the ETT below the thoracic inlet and > or =0.5 cm above the carina, was determined by chest radiograph. MEASUREMENTS AND MAIN RESULTS: Suggested ETT size based on the Pediatric Advanced Life Support (PALS) age-based formula and the Broselow tape-length-based guidelines were determined. A total of 174 of 226 ETTs (77%) were correctly positioned. If practitioners utilized the 3x ETT size for the actual tubes chosen, 170 of 226 (75%) would have been accurately placed. More accurate were the 3x PALS-based ETT size (81%) and 3x Broselow-suggested ETT size (85%). The use of the Broselow ETTs to determine the depth would have led to a significantly improved ETT position (p = .009) compared with the actual ETT. CONCLUSION: The commonly used formula of 3x tube size for ETT depth in children results in 15-25% malpositioned tubes. Practitioners can improve the reliability of this formula by utilizing the recommended ETT size as suggested by the Broselow tape. A more reliable method is necessary to avoid ETT malposition.
OBJECTIVE: To determine whether multiplying the internal diameter of the endotracheal tube (ETT) by 3 (3x ETT size) is a reliable method for determining correct depth of oral ETT placement in the pediatric population. DESIGN: Prospective, observational. SETTING: University-affiliated, 12-bed pediatric intensive care unit. PATIENTS: Orally intubated pediatric intensive care unit patients of < or =12 yrs of age. INTERVENTIONS: Demographics, ETT size, and depth of ETT placement measured from the lip were obtained. Correct placement, defined as the tip of the ETT below the thoracic inlet and > or =0.5 cm above the carina, was determined by chest radiograph. MEASUREMENTS AND MAIN RESULTS: Suggested ETT size based on the Pediatric Advanced Life Support (PALS) age-based formula and the Broselow tape-length-based guidelines were determined. A total of 174 of 226 ETTs (77%) were correctly positioned. If practitioners utilized the 3x ETT size for the actual tubes chosen, 170 of 226 (75%) would have been accurately placed. More accurate were the 3x PALS-based ETT size (81%) and 3x Broselow-suggested ETT size (85%). The use of the Broselow ETTs to determine the depth would have led to a significantly improved ETT position (p = .009) compared with the actual ETT. CONCLUSION: The commonly used formula of 3x tube size for ETT depth in children results in 15-25% malpositioned tubes. Practitioners can improve the reliability of this formula by utilizing the recommended ETT size as suggested by the Broselow tape. A more reliable method is necessary to avoid ETT malposition.
Authors: Jhon Jairo Rodríguez; Luis Felipe Higuita-Gutiérrez; Edwar Arturo Carrillo Garcia; Esneider Castaño Betancur; Mauricio Luna Londoño; Sara Restrepo Vargas Journal: Emerg Med Int Date: 2020-05-02 Impact factor: 1.112
Authors: Dayanna Letícia Silva Santos; Paulo Douglas de Oliveira Andrade; Evelim Leal de Freitas Dantas Gomes Journal: Rev Bras Ter Intensiva Date: 2020-07-13
Authors: Franziska Rost; Bernd Donaubauer; Holger Kirsten; Thomas Schwarz; Peter Zimmermann; Manuela Siekmeyer; Daniel Gräfe; Sebastian Ebel; Christian Kleber; Martin Lacher; Manuel Florian Struck Journal: Children (Basel) Date: 2022-02-18
Authors: Alexander R Schmidt; Lea Ulrich; Burkhardt Seifert; Roland Albrecht; Donat R Spahn; Philipp Stein Journal: Scand J Trauma Resusc Emerg Med Date: 2016-03-05 Impact factor: 2.953