Prospective assessment of guidelines for determining appropriate depth of endotracheal tube placement in children.
OBJECTIVE
To determine whether multiplying the internal diameter of the endotracheal tube (ETT) by 3 (3x ETT size) is a reliable method for determining correct depth of oral ETT placement in the pediatric population.


METHODS
Prospective, observational.


METHODS
University-affiliated, 12-bed pediatric intensive care unit.


METHODS
Orally intubated pediatric intensive care unit patients of < or =12 yrs of age.


METHODS
Demographics, ETT size, and depth of ETT placement measured from the lip were obtained. Correct placement, defined as the tip of the ETT below the thoracic inlet and > or =0.5 cm above the carina, was determined by chest radiograph.


RESULTS
Suggested ETT size based on the Pediatric Advanced Life Support (PALS) age-based formula and the Broselow tape-length-based guidelines were determined. A total of 174 of 226 ETTs (77%) were correctly positioned. If practitioners utilized the 3x ETT size for the actual tubes chosen, 170 of 226 (75%) would have been accurately placed. More accurate were the 3x PALS-based ETT size (81%) and 3x Broselow-suggested ETT size (85%). The use of the Broselow ETTs to determine the depth would have led to a significantly improved ETT position (p = .009) compared with the actual ETT.


CONCLUSIONS
The commonly used formula of 3x tube size for ETT depth in children results in 15-25% malpositioned tubes. Practitioners can improve the reliability of this formula by utilizing the recommended ETT size as suggested by the Broselow tape. A more reliable method is necessary to avoid ETT malposition.
Phipps
Lorri M
LM
Department of Pediatrics, Division of Nursing, Penn State Children's Hospital, Pennsylvania State University College of Medicine, Hershey, PA, USA.
Thomas
Neal J
NJ
Gilmore
Raymond K
RK
Raymond
Jill A
JA
Bittner
Toni R
TR
Orr
Richard A
RA
Robertson
Courtney L
CL
D000367:Age Factors; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000592:standards*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D014132:Trachea / Q000000981:diagnostic imaging