Reexamining the ideal depth of endotracheal tube in neonates

The appropriate endotracheal tube (ET) depth for the newborn with respiratory failure is important. Inappropriate ET depth increases the risk of uneven lung expansion and collapse. This retrospective study aimed to compare the final ideal ET depth with Tochen's formula in Taiwanese intubated neonates, and to determine the correlation between neonatal factors and final ideal ET depth, and to devise an accurate predictive formula for use in Taiwan. Methods: Data were collected from neonates who required endotracheal intubation and who were admitted to the Neonatal Intensive Care Unit from 2011 to 2015. Correlations between the final ideal ET depth, GA, and BW were assessed using the Pearson correlation test. Multiple regression analysis was used to produce a formula to predict appropriate ET depth from mouth angle to midtracheal position of neonates. Results: A total of 139 neonates were enrolled in this study. The final ideal ET depth was in concordance with Tochen's formula only in 19 neonates (13.7%); relatively deeper in 30 (21.6%) neonates; and shallower than the values from Tochen's formula in 90 (64.7%) neonates. Multiple regression analysis showed that the BW and GA together produced best prediction for final ideal ET depth in our study population. SGA and gender were shown to be insignificantly related to final ideal ET depth. Conclusion: Our study showed the final ideal ET depth was shallower than Tochen's formula in 64.7% of neonates. Tochen's formula might not be suitable to predict ET depth for neonates in Taiwan. In our study, the new formula: 4.0 + 1.0 BW (kg) + 0.05 GA (weeks) provides a more accurate value and alternative method for evaluating the final ideal ET depth in Taiwan. A practical guideline for Asian neonates should be validated by prospective studies with large sample sizes

Is Nasal Septum-Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study

Objective Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula=weight in kilograms+6cm; and nasal septum-tragus length [NTL]+1cm) used to determine the endotracheal tube (ETT) insertion depth. Study Design Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL+1cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2). Results A total of 167 infants (22-42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants34 weeks of gestational age and 56.8 vs. 45.0% in infants>34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of 34 weeks, especially in the NTL group (46% in the Tochen group and 60.7% in the NTL group). Conclusion The NTL+1cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of 1,500g. Therefore, more studies are needed to determine the optimal ETT insertion depth