Investigation of endotracheal tube position changes due to neck rotation in newborns

There are few reports describing endotracheal tube (ETT) position changes due to neck rotation. Modifying ultrasonographic measurements of ETT tip and aortic distance, we aim to clarify the ETT tip position changes due to neck rotation.

Eligibility criteria: (1) birth between October 2022 and September 2023, between 32 and 41 gestational weeks, (2) ventilatory management with ETT fixed at the left mouth corner, and (3) physician judgment that respiratory and circulatory status is relatively stable. We measured the distance between the brachiocephalic artery bifurcation and the ETT tip on one plane in a close parasagittal section from the left neck. We compared them with the neck in right, neutral, and left rotation positions as distances R, N, and L, respectively.

There were 30 study subjects. The means ± standard deviations of distances R, N, and L were 10.4 ± 2.1, 12.9 ± 3.5, and 13.7 ± 3.3 mm, respectively. Repeated measures analysis of variance found significant differences between groups (P < 0.001). A significant difference was found between distances R and N (mean difference - 2.50 [95 % confidence interval, -3.58, -1.42]) and between R and L (-3.31 [-4.72, -1.91]).

The tip position of ETT secured at the left mouth corner was significantly deeper in the right rotation neck position. In addition to left-right neck rotation, flexion-extension neck movement greatly affects ETT position change. Therefore, we must take care of neck movement.