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Randomised controlled trial: Shoulder-umbilicus length versus body weight measurement for optimal endotracheal tube
Adam Al-Anas Bin Mat Ali1, Ariffin Nasir1, Noraida Ramli1
1Paediatric Department, Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Malaysia.
Insights
Shoulder-umbilical length may be a better predictor for endotracheal tube (ETT) placement in infants than birthweight. This study found fewer ETT malpositions using shoulder-umbilical length, suggesting clinical significance.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Medical Engineering
Background:
- Optimal endotracheal tube (ETT) placement is critical for ventilated infants.
- Birthweight is commonly used to guide ETT depth but may not be the most accurate predictor.
- Accurate ETT placement prevents complications and improves patient outcomes.
Purpose of the Study:
- To compare shoulder-umbilical length against birthweight for predicting optimal ETT placement in Malaysian infants.
- To determine if shoulder-umbilical length reduces ETT malposition rates compared to birthweight.
Main Methods:
- A randomized controlled trial was conducted in a Malaysian tertiary hospital's NICU.
- Infants requiring ventilation were randomized into two groups: shoulder-umbilical length (experimental) and birthweight (control).
- The primary outcome was ETT malposition, identified via chest X-ray within 1 hour of intubation.
Main Results:
- 110 infants were randomized (55 per group).
- The experimental group (shoulder-umbilical length) had 23% ETT malposition, versus 40% in the control group (birthweight).
- The observed difference, while not statistically significant (P=0.06), suggests a potentially clinically significant improvement.
Conclusions:
- Shoulder-umbilical length demonstrated a trend towards reducing endotracheal tube malposition compared to birthweight.
- While further research with larger sample sizes is warranted, the findings suggest shoulder-umbilical length may be a more clinically relevant predictor for ETT placement.
- This measurement could potentially improve patient care in neonatal intensive care units.
Aim:
The optimal placement of the endotracheal tube (ETT) in ventilated infants is essential, but birthweight may be not the best parameter to predict it. The aim of this study was a direct comparison of shoulder-umbilical length (experimental group) versus birthweight (control group) as predictor of optimal ETT placement in Malaysian ventilated infants.
Methods:
All infants requiring ventilation in the neonatal intensive care unit of a tertiary hospital in Malaysia during the 4-month study period were eligible to enter this randomised controlled trial. All participants were randomised into two groups: experimental and control group. The main outcome measure was malposition of the ETT (requiring adjustment), as seen on the chest X-ray performed within 1 h after intubation. Tube placement was assessed by two neonatologists, blinded to the allocation.
Results:
One hundred and ten infants were randomised, 55 in each group. The ETT was malpositioned in 13 of 55 infants (23%) for the experimental group and 22 of 55 infants (40%) in the control group (P = 0.06).
Conclusion:
In the experimental group, fewer infants showed a need for tube adjustment than in the control group. While a larger study may be necessary to show statistical significance, the difference shown in this study may be large enough to be of clinical significance.
