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Updated: Aug 27, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Effect of head position changes on the depth of tracheal intubation in pediatric patients: A prospective,
Peier Zhuang1, Weikai Wang1, Minghua Cheng1
1Department of Anesthesiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Insights
Head position changes significantly affect endotracheal tube (ETT) depth in pediatric patients. Using reinforced ETTs can minimize ETT displacement and reduce complications during surgery.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Airway Management
Background:
- Endotracheal intubation is a common procedure in pediatric surgery.
- Maintaining correct endotracheal tube (ETT) depth is crucial for patient safety.
- Head positioning can alter ETT depth, potentially leading to complications.
Purpose of the Study:
- To investigate how changes in head position affect ETT depth in pediatric patients.
- To assess the risk of inadvertent extubation and bronchial intubation due to head movements.
Main Methods:
- Pediatric patients (4-12 years) undergoing elective surgery with orotracheal intubation were enrolled.
- ETT tip-to-carina distance was measured using flexible endoscopy in various head positions (neutral, flexion, extension, rotation).
- ETT tip displacement and adverse events were recorded; comparisons were made between reinforced and taper guard ETTs.
Main Results:
- Head flexion moved the ETT tip 0.5 cm towards the carina (P < 0.001).
- Head extension moved the ETT tip 0.9 cm towards the vocal cords (P < 0.001).
- Reinforced ETTs showed less displacement than taper guard ETTs.
Conclusions:
- Head position changes, particularly extension, significantly influence ETT depth in pediatric patients.
- Using reinforced ETTs is recommended to minimize ETT displacement and prevent intubation-related complications.
Purpose:
The purpose of this study was to investigate the effect of changing head position on the endotracheal tube (ETT) depth and to assess the risk of inadvertent extubation and bronchial intubation in pediatric patients.
Methods:
Subjects aged 4-12 years old with orotracheal intubation undergoing elective surgeries were enrolled. After induction, the distances between "the ETT tip and the trachea carina" (T-C) were measured using a Disposcope flexible endoscope in head neutral position, 45° extension and flexion, 60° right and left rotation. The distance of the ETT tip movement relative to the neutral position (ΔT-C) was calculated after changing the head positions. The direction of the ETT tip displacement and the adverse events including endobronchial intubation, accidental tracheal extubation, hoarseness and sore throat were recorded.
Results:
The ETT tip moved toward the carina by 0.5 ± 0.4 cm (P < 0.001) when the head was flexed. After extending the head, the ETT tip moved toward the vocal cord by 0.9 ± 0.4 cm (P < 0.001). Right rotation resulted that the ETT tip moved toward the vocal cord direction by 0.6 ± 0.4 cm (P < 0.001). Moreover, there was no displacement with the head on left rotation (P = 0.126). Subjects with the reinforced ETT had less ETT displacement after changing head position than the taper guard ETT.
Conclusion:
The changes of head position can influence the depth of the ETT especially in head extension. We recommend using the reinforced ETT to reduce the ETT displacement in pediatrics to avoid intubation complications.
Clinical Trial Registration:
[www.ClinicalTrials.gov], identifier, [ChiCTR2100042648].
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