Randomised trial of estimating oral endotracheal tube insertion depth in newborns using weight or vocal cord guide

Area of Science:

• Neonatal medicine
• Pediatric critical care
• Medical device usability

Background:

• Accurate endotracheal tube (ETT) placement in newborns is crucial for effective ventilation and preventing injury.
• Current methods often rely on infant weight for depth estimation, leading to frequent malpositioning, typically too deep.
• The vocal cord guide on the ETT has been proposed as an alternative method to improve insertion accuracy.

Purpose of the Study:

• To compare the effectiveness of the vocal cord guide versus weight-based estimation for achieving correct ETT tip positioning in newborns.
• To evaluate whether the vocal cord guide reduces the incidence of ETT malpositioning.

Main Methods:

• A single-center randomized controlled trial was conducted in a neonatal intensive care unit (NICU).
• Newborn infants undergoing intubation were randomized to ETT depth estimation using either weight (cm = kg + 6) or the vocal cord guide.
• Correct ETT position was defined as the tip between the T1 and T2 vertebrae on chest X-ray, assessed by a blinded pediatric radiologist.

Main Results:

• A total of 136 infants were randomized into the study.
• The proportion of correctly positioned ETTs was similar between the weight-based group (44%) and the vocal cord guide group (40%), with no statistically significant difference (p=0.731).
• The majority of incorrectly positioned ETTs (87%) were found to be inserted too deep.

Conclusions:

• Estimating endotracheal tube insertion depth using the vocal cord guide does not improve the accuracy of tip positioning in newborns compared to weight-based methods.
• The study indicates that neither method consistently achieves optimal ETT placement, with a tendency for tubes to be placed too deep.