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Accuracy of Advanced Pediatric Life Support Intubation Depth Formula in Indian Children Aged 1 to 12 Years

Sagar Agrawal1, Vishal Kumar2, Maansi Gangwal1

  • 1Department of Pediatrics, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi.

Indian Pediatrics
|October 12, 2023
PubMed

Insights

The Advanced Pediatric Life Support (APLS) endotracheal tube (ET) depth formula prevents bronchial intubation in Indian children but often places the tube too deep. Accuracy improved to 50% when considering only the safe distance to the carina.

Area of Science:

  • Pediatric Emergency Medicine
  • Critical Care
  • Anesthesiology

Background:

  • Endotracheal intubation is a critical procedure in pediatric emergencies.
  • Accurate endotracheal tube (ET) depth is essential to prevent complications like bronchial intubation or esophageal placement.
  • The Advanced Pediatric Life Support (APLS) formula is a widely used guideline for determining ET depth.

Purpose of the Study:

  • To assess the accuracy of the APLS endotracheal tube depth formula in Indian children.
  • To evaluate the formula's effectiveness in preventing mainstem bronchial intubation.
  • To determine the optimal criteria for assessing appropriate ET depth in this population.

Main Methods:

  • A prospective study involving 86 children aged 1-12 years requiring intubation.
  • Endotracheal tube depth was initially set using the APLS formula.
  • Chest X-rays were used to evaluate ET depth accuracy based on vertebral levels and safe distance from the carina.

Main Results:

  • No cases of bronchial intubation were observed.
  • The APLS formula achieved an accuracy of 37.2% for appropriate ET depth.
  • Deep placement occurred in 57% of cases; redefining deep placement based on safe distance to carina improved accuracy to 50%.

Conclusions:

  • The APLS formula is effective in preventing bronchial intubation in Indian children.
  • The formula tends to overestimate ET depth, with 50% of cases showing deep placement when considering the safe distance to the carina.
  • Revising placement criteria based on safe distance to carina may enhance accuracy.
Abstract

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