Is It Time to Review Guidelines for ETT Positioning in the NICU? SCEPTIC-Survey of Challenges Encountered in Placement of Endotracheal Tubes in Canadian NICUs

Pankaj Sakhuja, Michael Finelli, Judy Hawes, Hilary Whyte, Pankaj Sakhuja, Michael Finelli, Judy Hawes, Hilary Whyte

Abstract

Objectives. To examine current opinions and practices regarding endotracheal tube placement across several Canadian Neonatal Intensive Care Units. Design. Clinical directors from Canadian Neonatal Network affiliated NICUs and Neonatal-Perinatal Programs across Canada were invited via email to participate in and disseminate the online survey to staff neonatologists, neonatal fellows, respiratory therapists, and nurse practitioners. Result. There is wide variability in the beliefs and practices related to ETT placement. The majority use "weight +6" formula and "aim to black line" on ETT at vocal cords to estimate the depth of an oral ETT and reported estimation as challenging in ELBW infants. The majority agreed that mid-trachea is an ideal ETT tip position; however their preferred position on chest X-ray varied. Many believe that ETT positioning could be improved with more precise ETT markings. Conclusion. Further research should focus on developing more effective guidelines for ETT tip placement in the ELBW infants.

References

    1. Kempley S. T., Moreiras J. W., Petrone F. L. Endotracheal tube length for neonatal intubation. Resuscitation. 2008;77(3):369–373. doi: 10.1016/j.resuscitation.2008.02.002.
    1. Mainie P., Carmichaal A., McCullough S., Kempley S. T. Endotracheal tube position in neonates requiring emergency inter-hospital transfer. American Journal of Perinatology. 2006;23(2):121–124. doi: 10.1055/s-2006-931915.
    1. Australian and New Zealand Resuscitation Council Guideline 13.5: Tracheal Intubation for Ventilation, 2010.
    1. Resuscitation Council (UK) Newborn Life Support. 3rd. chapter 13 2011. Tracheal intubation.
    1. Richmond S., Wyllie J. European Resuscitation Council Guidelines for Resuscitation 2010 Section 7. Resuscitation of babies at birth. Resuscitation. 2010;81(10):1389–1399. doi: 10.1016/j.resuscitation.2010.08.018.
    1. Kattwinkel J. Neonatal Resuscitation. 6th. American Academy of Pediatrics; 2011.
    1. Rotschild A., Chitayat D., Puterman M. L., Phang M. S., Ling E., Baldwin V. Optimal positioning of endotracheal tubes for ventilation of preterm infants. The American Journal of Diseases of Children. 1991;145(9):1007–1012.
    1. Balu R., Bustani P. Are we focusing on the wrong end of the neonatal endotracheal tube? Archives of Disease in Childhood. 2010;95, article A89
    1. Verghese S. T., Hannallah R. S., Slack M. C., Cross R. R., Patel K. M. Auscultation of bilateral breath sounds does not rule out endobronchial intubation in children. Anesthesia & Analgesia. 2004;99(1):56–58. doi: 10.1213/01.ane.0000118104.23660.f3.
    1. Blayney M. P., Logan D. R. First thoracic vertebral body as reference for endotracheal tube placement. Archives of Disease in Childhood. 1994;71(1):F32–F35.
    1. Tochen M. L. Orotracheal intubation in the newborn infant: a method for determining depth of tube insertion. The Journal of Pediatrics. 1979;95(6):1050–1051. doi: 10.1016/s0022-3476(79)80309-1.
    1. Noback G. J. The developmental topography of the larynx, trachea lungs in the fetus, new-born, infant and child. American Journal of Diseases of Children. 1923;26(6):515–533. doi: 10.1001/archpedi.1923.04120180014002.
    1. Hudgins P. A., Siegel J., Jacobs I., Abramowsky C. R. The normal pediatric larynx on CT and MR. American Journal of Neuroradiology. 1997;18(2):239–245.
    1. Wong D. T., Weng H., Lam E., Song H.-B., Liu J. Lengthening of the trachea during neck extension: which part of the trachea is stretched? Anesthesia & Analgesia. 2008;107(3):989–993. doi: 10.1213/ane.0b013e31817ef177.
    1. Peterson J., Johnson N., Deakins K., Wilson-Costello D., Jelovsek J. E., Chatburn R. Accuracy of the 7-8-9 rule for endotracheal tube placement in the neonate. Journal of Perinatology. 2006;26(6):333–336. doi: 10.1038/sj.jp.7211503.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner