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Updated: Aug 16, 2026
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Intubation depth markings allow an improved positioning of endotracheal tubes in children
Markus Weiss1, Christian Balmer, Alexander Dullenkopf
1Department of Anesthesia, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland. markus.weiss@kispi.unizh.ch
Insights
The Microcuff pediatric tracheal tube markings ensure safe intubation depth, preventing endobronchial placement and laryngeal cuff issues. This method is superior to standard formulas for pediatric tracheal intubation.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Medical Device Evaluation
Background:
- Accurate tracheal tube placement is critical in pediatric patients.
- Existing methods for determining intubation depth can be imprecise.
- The Microcuff pediatric tracheal tube is a novel device with specific depth markings.
Purpose of the Study:
- To assess the accuracy of the Microcuff pediatric tracheal tube's depth markings.
- To evaluate the safety of tube placement using these markings.
- To compare the markings' efficacy against standard pediatric intubation formulas.
Main Methods:
- Prospective evaluation of the Microcuff pediatric tracheal tube in pediatric patients (birth to 16 years).
- Intubation depth was guided by the tube's markings, with the tip placed at the vocal cords.
- Post-intubation X-rays measured the distance from the tube tip to the tracheal carina.
Main Results:
- Tracheal tube tip advancement ranged from 40.6% to 68.6% (median 51.4%) into the trachea.
- The shortest distance to the carina was 15.7 mm with a 3.0 mm internal diameter tube.
- Standard formula prediction resulted in potential endobronchial or laryngeal cuff placement in some cases.
Conclusions:
- The Microcuff pediatric tracheal tube's depth markings facilitate safe placement, avoiding endobronchial intubation.
- The markings ensure a cuff-free laryngeal zone, enhancing patient safety.
- Placement guided by Microcuff markings proved more reliable than standard insertion formulas.
Objectives:
To evaluate the position of the new Microcuff pediatric tracheal tube, based upon intubation depth markings.
Methods:
With Institutional Ethics Committee approval and informed parental consent, we included patients from birth (> or = 3 kg) to 16 yr undergoing interventional cardiac catheterization requiring general anesthesia with orotracheal intubation. The intubation depth mark of the tracheal tube was placed between the vocal cords by direct laryngoscopy. The distance between tube tip and tracheal carina was measured from routinely taken cardiac catheterization posterior-anterior x-ray computer images with the patient supine and the head in a neutral position. Evaluation was performed for 20 tubes size 3.0 mm internal diameter (ID) and for ten tubes of each size from 3.5 to 7.0 mm ID.
Results:
100 patients were studied (47 girls; 53 boys). Tracheal tube tip advancement into the trachea ranged from 40.6% to 68.6% (median 51.4%). The shortest distance from tube tip to the tracheal carina was 15.7 mm using a 3.0 mm ID tube. Using a standard formula for tube insertion in children aged > or = two years [12 cm + (age/2)], in one patient the tube tip would have been below the carina and in seven patients the tube cuffs would have been placed within the larynx.
Conclusions:
The intubation depth markings of the new Microcuff pediatric tracheal tube allow safe placement of the tracheal tube with a cuff-free laryngeal zone without the risk for endobronchial intubation. Placement using the intubation depth markings was superior to predicted insertion using a standard formula.
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