title: Accuracy of a Chest X-Ray-Based Method for Predicting the Depth of Insertion of Endotracheal Tubes in Pediatric Patients Undergoing Cardiac Surgery.
abstract: OBJECTIVE
  The incidence of endotracheal tube (ETT) malposition in children with various described methods is 15% to 30%. Chest x-ray (CXR) is the gold standard for confirming appropriate ETT position. The aim of this study was to measure the accuracy of a preoperative CXR-based method in determining depth of insertion of ETTs and to compare it with methods based on the intubation depth mark or formulae (age, height, and ETT internal diameter) in children undergoing cardiac surgery.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University-affiliated tertiary care hospital.
  
  
  METHODS
  Sixty-six consecutive children scheduled for elective pediatric cardiac surgery.
  
  
  METHODS
  None.
  
  
  RESULTS
  The distance from carina to mid-trachea was measured for each child preoperatively on the CXR displayed as a computed radiography image in a picture archival and communications system computer. Following intubation, ETTs deliberately were pushed endobronchially and then pulled back to the carina; they were further withdrawn by the previously measured carina to mid-tracheal distance and secured. CXRs postoperatively were repeated to confirm ETT position. The ETT position was measured with other methods using the picture archival and communications system ruler on the postoperative CXR and compared with the CXR method. The proportion of appropriate ETT position with the CXR method was 98.5% (p≤0.001 v other methods). In children younger than 3 years, the appropriate proportion was 97.4%.
  
  
  CONCLUSIONS
  The appropriate positioning of ETTs in the trachea by the CXR method is superior to other methods.
authors.affiliation: Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India. Electronic address: koshy61@rediffmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Koshy
authors.affiliation: Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
authors.forename: Satyajeet
authors.initials: S
authors.lastname: Misra
authors.affiliation: Department of Anesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
authors.forename: Nilay
authors.initials: N
authors.lastname: Chatterjee
authors.affiliation: Department of Cardiovascular Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
authors.forename: Baiju S
authors.initials: BS
authors.lastname: Dharan
mesh_terms: D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D014132:Trachea / Q000000981:diagnostic imaging
keywords: airway; anesthesia; cardiac surgery; carina; chest x-ray; children; depth of insertion; endotracheal tube