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Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

Prospective assessment of guidelines for determining appropriate depth of endotracheal tube placement in children

Lorri M Phipps1, Neal J Thomas, Raymond K Gilmore

  • 1Department of Pediatrics, Division of Nursing, Penn State Children's Hospital, Pennsylvania State University College of Medicine, Hershey, PA, USA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|September 9, 2005
PubMed

Insights

The common 3x endotracheal tube (ETT) size formula for pediatric depth placement is unreliable, leading to malposition in 15-25% of cases. Using Broselow tape recommendations significantly improves ETT positioning accuracy.

Area of Science:

  • Pediatric Critical Care Medicine
  • Airway Management
  • Medical Device Efficacy

Background:

  • Accurate endotracheal tube (ETT) depth is crucial for effective ventilation and preventing complications in pediatric patients.
  • Current methods for determining ETT depth, such as the 3x internal diameter (ID) rule, have shown variable reliability.
  • Malpositioned ETTs can lead to significant morbidity and mortality in pediatric intensive care unit (PICU) settings.

Purpose of the Study:

  • To evaluate the reliability of the 3x ETT size formula for oral ETT placement depth in pediatric patients.
  • To compare the accuracy of the 3x ETT size formula with Broselow tape and Pediatric Advanced Life Support (PALS) guidelines for ETT depth determination.
  • To identify a more reliable method for ensuring correct ETT placement in the PICU.

Main Methods:

  • Prospective, observational study conducted in a university-affiliated pediatric intensive care unit.
  • Data collected included demographics, ETT size, and measured depth from the lip for orally intubated pediatric patients (<=12 years).
  • Correct ETT placement was confirmed by chest radiograph, defined as ETT tip below the thoracic inlet and >0.5 cm above the carina.

Main Results:

  • Out of 226 ETTs, 77% were correctly positioned using standard practices.
  • Applying the 3x ETT size formula resulted in 75% accurate placement.
  • Using 3x PALS-based ETT size (81%) and 3x Broselow-suggested ETT size (85%) showed improved accuracy, with Broselow tape guidance leading to significantly better ETT positioning (p = .009).

Conclusions:

  • The conventional 3x ETT size formula for determining pediatric ETT depth is associated with a 15-25% malposition rate.
  • Utilizing Broselow tape-recommended ETT sizes enhances the reliability of depth determination compared to the 3x ETT size formula.
  • Development of a more dependable method for ETT depth placement is essential to minimize malpositioning in pediatric patients.
Abstract

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