title: Endotracheal tube position in neonates requiring emergency interhospital transfer.
abstract: A malpositioned endotracheal tube (ETT) is common following initial intubation. This study assessed ETT position in 53 orotracheally intubated neonates referred for interhospital transfer during a 3-month period. Position of the ETT on first chest radiograph (CXR) after intubation was assessed and related to radiographic lung expansion, with documentation that the final ETT length had achieved a satisfactory position. At the time of first CXR, median ETT length at the lips was 7.0 cm (range, 5 to 12 cm) with median tip position at T3.0 (range, C7 to T6). The ETT required repositioning in 58% of patients. Most malpositioned tubes were too low (26 were withdrawn and only four were advanced; p < 0.001), with lung expansion more closely related to vertebral than clavicular position of the ETT. Final ETT length correlated well with corrected gestation ( r = 0.83; p < 0.01) and marginally less well with weight ( r = 0.79; p < 0.01). From the regression analysis, we provide a table of recommended tube lengths by gestation.
authors.affiliation: Neonatal Transfer Service for London, Barts and the London NHS Trust, London, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Mainie
authors.forename: A
authors.initials: A
authors.lastname: Carmichael
authors.forename: S
authors.initials: S
authors.lastname: McCullough
authors.forename: S T
authors.initials: ST
authors.lastname: Kempley
mesh_terms: D000402:Airway Obstruction / Q000209:etiology* / Q000628:therapy; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011336:Probability; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome