Related Experiment Video
Updated: Jul 18, 2026
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Endotracheal tube size estimation for children with pathological short stature
Reza James Daugherty1, Vinay Nadkarni, Bruce Randall Brenn
1Division of Pediatric Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. rdaugher@nemours.org
Insights
Length-based endotracheal tube (ETT) sizing is as accurate as age-based methods for children, including those with pathological short stature (PSS). This finding supports using length for more precise ETT selection in pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Medical Device Sizing
- Growth Abnormalities
Background:
- Accurate endotracheal tube (ETT) sizing is critical for pediatric airway management.
- Children with pathological short stature (PSS) present unique challenges for ETT selection.
- Current ETT sizing relies on age-based formulas, which may be less accurate in PSS.
Purpose of the Study:
- To compare the accuracy of length-based and age-based ETT size estimations.
- To evaluate these estimations against anesthesiologist-selected ideal ETT size.
- To assess accuracy in children with normal growth versus those with PSS.
Main Methods:
- Retrospective review of 5,175 pediatric tracheal intubations.
- Classified children into normal length and PSS groups (<5% length for age).
- Compared predicted ETT sizes (age- and length-based) to anesthesiologist-selected sizes within +/-0.5 mm.
Main Results:
- Length-based ETT prediction was accurate in 92.8% of normal stature children and 92.2% of PSS children.
- Age-based ETT prediction was accurate in 89.8% of normal stature children and 86.6% of PSS children.
- Both age and length showed strong correlations with actual ETT size used (r=0.91-0.93).
Conclusions:
- Length-based ETT size prediction is at least as accurate as age-based estimation.
- This holds true for both children with normal growth and those with PSS.
- Length-based sizing offers a reliable alternative for pediatric ETT selection.
Objective:
To compare length-based estimates of endotracheal tube (ETT) size and age-based estimates with anesthesiologist-selected ideal ETT size in children with medical conditions affecting normal growth, known as pathological short stature (PSS).
Methods:
We conducted a retrospective review of the anesthesia database of all children undergoing tracheal intubation for any surgical procedure during a 3-year period. The anesthesiologist-selected ideal ETT size was defined as that selected and successfully used throughout the case under the supervision of a board-certified pediatric anesthesiologist. Objective criteria, such as leak test and adequate oxygenation/ventilation, were used to validate the appropriateness of the ETT chosen. For analysis, the children were classified as normal length for age versus PSS, defined as less than 5% length for age on the Centers for Disease Control and Prevention growth chart. The proportions of clinically relevant predicted ETTs, within +/-0.5 mm of the anesthesiologist-selected ideal ETT size, based on both age- and length-based formulas for each group were then compared.
Results:
Five thousand one hundred seventy-five patient records were analyzed. In children with normal stature, age-predicted ETT size was within the clinically relevant range in 89.8% (95% confidence interval [CI], 88.9%-90.7%), and length-predicted ETT size was within the clinically relevant range in 92.8% (95% CI, 92.0%-93.6%). In children with PSS, age-predicted ETT size was within the clinically relevant range in 86.6% (95% CI, 84.3%-89.0%), and length-predicted ETT size was within the clinically relevant range in 92.2% (95% CI, 90.3%-94.0%). The correlation coefficient for age to anesthesiologist-selected ideal ETT size was strong for both normal and PSS patients (r = 0.91 and r = 0.93, respectively). Length was also highly correlated to actual ETT size used for both groups (r = .91).
Conclusions:
Length-based prediction of ETT size is at least as accurate as age-based estimation in both normal and pathologically short children.
Related Concept Videos
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:28Tracheostomy: Procedure and Tubes
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
01:27Physical Assessment of the Respiratory Tract II: Inspection
Chest Configuration
The chest configuration can...