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A comparative study of endotracheal tube positioning methods in children: safety from neck movement

Seung-Yeon Yoo1, Jin-Hee Kim, Sung-Hee Han

  • 1Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam City, Korea. anesing1@snu.ac.kr

Anesthesia and Analgesia
|August 25, 2007
PubMed

Insights

Endotracheal tube (ETT) placement using auscultation in children risks deeper positioning and endobronchial intubation during neck flexion. Alternative methods ensure safer ETT positioning, preventing complications.

Area of Science:

  • Pediatric Anesthesiology
  • Airway Management
  • Critical Care Medicine

Background:

  • Endotracheal tube (ETT) displacement due to neck movement can lead to endobronchial intubation or accidental extubation.
  • ETT position can shift even after initial clinical or radiographic confirmation.

Purpose of the Study:

  • To evaluate the impact of different endotracheal intubation confirmation methods on ETT tip position during neck movement in children.
  • To determine the safest method for ETT placement in pediatric patients to prevent complications.

Main Methods:

  • 107 children (2-8 years) were randomly assigned to three groups based on ETT confirmation technique: auscultation, vocal cord marking, or suprasternal notch palpation.
  • Fiberoptic bronchoscopy measured ETT tip distance to the carina, assessing its relative position (0%=carina, 100%=vocal cords) during neutral and flexed neck positions.

Main Results:

  • Auscultation (Group I) resulted in the deepest ETT placement (21.4% +/- 6.7% from carina) compared to vocal cord marking (46.5%) and suprasternal notch palpation (43.4%).
  • Neck flexion in Group I led to significant ETT advancement (9.5% +/- 10.3%), causing endobronchial intubation in 14.3% of cases.
  • No endobronchial intubation or extubation occurred in Groups II and III during neck movement.

Conclusions:

  • Auscultation for ETT placement positions the tube deeper in the trachea, increasing the risk of endobronchial intubation with neck flexion.
  • Vocal cord marking and suprasternal notch palpation are safer methods for pediatric endotracheal intubation, minimizing displacement risks.
Abstract

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