Influence of head and neck position on endotracheal tube tip position on chest x-ray examination: a potential problem in the infant undergoing intubation.
Complications related to endotracheal tubes are frequent in small children and infants. We report a case of a burned 12-month-old child in whom frequent manipulation of the endotracheal tube was required because of recurrent atelectasis and changing position of the endotracheal tube on chest x-ray film. It was then determined that because of variations in head and neck position while chest x-ray films were obtained, the endotracheal tip changed position in the trachea greater than 2.7 cm (greater than 1 inch), although endotracheal tube position was maintained at the level of the teeth. Airway care and gas exchange were subsequently improved by ensuring that patient care and chest x-ray films were performed with the head and neck in similar (neck slightly flexed, head neutral) position.
Trout
S
S
Department of Surgery, University of California, San Diego Medical Center.
Aaron
J
J
Zapta-Sirvent
R L
RL
Hansbrough
J F
JF
D001986:Bronchial Spasm / Q000000981:diagnostic imaging / Q000209:etiology*; D002056:Burns / Q000628:therapy; D005260:Female; D006257:Head; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D009333:Neck; D011187:Posture; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology*; D013902:Radiography, Thoracic / Q000379:methods