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Comparison of Two Modified Nasal-Tragus Length Methods for Estimating Orotracheal Tube Depth in Thai Neonates: A
Introduction:
Various recommendations have been proposed to estimate the proper orotracheal tube insertion depth (Pro-depth). This study aimed to compare the performance of two modified nasal-tragus length (NTL)-based methods-the NTL-based table (T-method) and a modified NTL-based formula (F-method: NTL + 1 cm for NTL ≤ 6.5 cm and NTL + 0.5 cm for NTL > 6.5 cm)-for estimating Pro-depth in Thai neonates.
Methods:
In this randomized controlled trial, Thai neonates undergoing orotracheal intubation were assigned to either method. Estimated insertion depth was compared with radiographically determined Pro-depth. Accuracy and short-term respiratory complications, including bronchial intubation, atelectasis, and unplanned extubation, were compared between groups.
Results:
Thirty-nine and forty-four neonates were allocated to the T-method and F-method groups, respectively. Both methods demonstrated strong correlations with Pro-depth (r = .87 vs .92, p = 0.305). The T-method slightly underestimated depth, whereas the F-method slightly overestimated depth (-0.03 ± 0.65 cm vs 0.11 ± 0.62 cm, p = .314). The F-method showed a higher rate of optimal ETT placement within the mid-intrathoracic target zone (49% vs 61%, p = .247), with no significant difference in short-term respiratory complications.
Conclusion:
Both modified NTL-based methods demonstrated comparable accuracy and safety in Thai neonates. The F-method showed a trend toward improved optimal positioning within the mid-intrathoracic trachea, although the difference did not reach statistical significance. Radiographic confirmation remains essential to minimize the risk of clinically significant complications.