Are preformed endotracheal tubes appropriately designed for pediatric patients?

The aim of the study was to examine different brands of preformed oral and nasal endotracheal tubes (ETT) and to assess whether the bend placement gave acceptable guidance for ETT depth positioning in children.

The distance from the vertex of the bend to the tip (bend-to-tip distance) of seven brands of preformed oral and nasal ETTs were measured. Front teeth-to-carina (FTC) and nares-to-carina (NC) distance data from orally (0-19 years) and nasally (0-8 years) intubated children were used to assess the risk of endobronchial intubation if a preformed ETT had been placed with its bend at the front teeth or nares.

While the bend-to-tip distance of a cuffed oral preformed ETT only differed by 0-1 cm from a same size ETT from another brand, uncuffed oral ETTs differed by 0-4 cm. The bend-to-tip distance of cuffed and uncuffed ETTs of the same brand and size differed by 0-3 cm. Had preformed cuffed oral ETTs been placed with their bends at the front teeth in children of the FTC reference group, endobronchial intubation would have occurred in 0-27% of the patients, depending on the size and brand of the used ETT. In contrast to oral ETTs, the bend-to-tip distance of cuffed nasal ETTs differed more (0-5.5 cm) between brands, and uncuffed nasal ETTs less (0-3 cm). Also, the bend-to-tip distance of a cuffed nasal ETT was consistently greater (2-9 cm) than that of a same brand and size nasal uncuffed ETT. Had a preformed cuffed nasal ETT been placed with its bend at the nares in the NC reference group, 50-100% of the patients would have been endobronchially intubated.

The bend-to-tip distance of preformed ETTs varies between brands, especially for nasal tubes. Some preformed tubes are not well suited for routine use in children. There is a high risk for accidental endobronchial intubation if a cuffed preformed ETT is positioned with its bend at the front teeth or nares in a young child. ETT tube tip position needs to be carefully controlled when a preformed ETT is used in a child.