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[Estimation of the optimal tube length : Systematic review article on published formulae for infants and children]

M Boensch1, V Schick2, O Spelten2

  • 1Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland. Marc.Boensch@uk-koeln.de.

Der Anaesthesist
|December 24, 2015
PubMed

Insights

Accurate endotracheal tube placement in children is critical. Published formulas for estimating tube depth have limitations, with a maximum 81% concordance, necessitating clinical verification.

Area of Science:

  • Pediatric Anesthesiology
  • Critical Care Medicine
  • Respiratory Management

Background:

  • Correct endotracheal tube (ETT) placement in children is vital to prevent complications like volutrauma and hypoxia.
  • Existing formulas for nasotracheal and orotracheal tube placement often rely on body weight and age.

Purpose of the Study:

  • To identify and compare published formulas for estimating correct ETT placement in pediatric patients.
  • To analyze the advantages and disadvantages of various ETT depth estimation formulas.

Main Methods:

  • A comprehensive literature search of Medline and PubMed was conducted using specific keywords related to pediatric anesthesia and ETT placement.
  • 13 distinct formulas for ETT insertion depth were identified and analyzed for both orotracheal and nasotracheal intubation.
  • Formulas were categorized for newborns/infants and older children (1-16 years), with independent assessment by anesthesiology and pediatric specialists.

Main Results:

  • 16 relevant publications yielded 13 different formulas for ETT depth estimation.
  • For children aged 1-16 years, 7 formulas were found (6 age-based, 1 weight-based).
  • For newborns and infants, 6 formulas were identified (4 weight-based, 1 length-based, 1 gestational age-based).

Conclusions:

  • Published formulas for pediatric ETT depth are simple but have significant limitations.
  • Age-based formulas showed a maximum 81% concordance with chest X-rays for both intubation types and age groups.
  • A gestational age-based formula showed some utility for newborns/infants, but no single formula is universally recommended without clinical confirmation (auscultation or X-ray).
Abstract

Keywords:
AgeBody weightEndotracheal intubationInsertion depthPediatric anesthesia

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