Is Nasal Septum–Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study

Özgün Uygur; Mehmet Yekta Öncel; Gülsüm Kadıoğlu Şimşek; Nilüfer Okur; Kıymet Çelik; Özlem Bozkurt; Ebru Yücesoy; Demet Terek; Meltem Koyuncu Arslan; Yeliz Pekçevik; Melek Akar; Özge Altun Köroğlu; Suna Oğuz; Nilgün Kültürsay

doi:10.1055/s-0039-3400982

American Journal of Perinatology, Table of Contents

Am J Perinatol 2021; 38(07): 728-733
DOI: 10.1055/s-0039-3400982

Original Article

Is Nasal Septum–Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study

Özgün Uygur

¹Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey

,

Mehmet Yekta Öncel

²Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Izmir Katip Çelebi University, Izmir, Turkey

,

Gülsüm Kadıoğlu Şimşek

³Clinic of Neonatology, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey

,

Nilüfer Okur

⁴Clinic of Neonatology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey

,

Kıymet Çelik

⁴Clinic of Neonatology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey

,

Özlem Bozkurt

⁵Clinic of Neonatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey

,

Ebru Yücesoy

⁵Clinic of Neonatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey

,

Demet Terek

⁶Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey

,

Meltem Koyuncu Arslan

¹Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey

,

Yeliz Pekçevik

⁷Department of Radiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey

,

Melek Akar

¹Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey

,

Özge Altun Köroğlu

⁶Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey

,

Suna Oğuz

³Clinic of Neonatology, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey

,

Nilgün Kültürsay

⁶Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey

› Author Affiliations

Abstract

Objective Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum–tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth.

Study Design Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2).

Results A total of 167 infants (22–42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants < 34 weeks of gestational age and 56.8 vs. 45.0% in infants > 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of <34 weeks, especially in the NTL group (46% in the Tochen group and 60.7% in the NTL group).

Conclusion The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of <1,500 g. Therefore, more studies are needed to determine the optimal ETT insertion depth.

Keywords

endotracheal tube placement - intubation - nasal septum–tragus length - newborn

Full Text

References

References
1 Flinn AM, Travers CP, Laffan EE, O'Donnell CP. Estimating the endotracheal tube insertion depth in newborns using weight or gestation: a randomised trial. Neonatology 2015; 107 (03) 167-172
2 Lee D, Mele PC, Hou W, Decristofaro JD, Maduekwe ET. The oro-helical length accurately predicts endotracheal tube insertion depth in neonates. J Pediatr 2018; 200: 265-269
3 Thayyil S, Nagakumar P, Gowers H, Sinha A. Optimal endotracheal tube tip position in extremely premature infants. Am J Perinatol 2008; 25 (01) 13-16
4 Tochen ML. Orotracheal intubation in the newborn infant: a method for determining depth of tube insertion. J Pediatr 1979; 95 (06) 1050-1051
5 Peterson J, Johnson N, Deakins K, Wilson-Costello D, Jelovsek JE, Chatburn R. Accuracy of the 7-8-9 rule for endotracheal tube placement in the neonate. J Perinatol 2006; 26 (06) 333-336
6 Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation 2008; 77 (03) 369-373
7 Sawyer T, Umoren RA, Gray MM. Neonatal resuscitation: advances in training and practice. Adv Med Educ Pract 2016; 8: 11-19
8 Perkins GD, Olasveengen TM, Maconochie I. et al; European Resuscitation Council. European Resuscitation Council Guidelines for Resuscitation: 2017 update. Resuscitation 2018; 123: 43-50
9 Weiner GM, Zaichkin J, Kattwinkel J. eds. Textbook of Neonatal Resuscitation. 7th ed. Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association; 2016
10 Gill I, Stafford A, Murphy MC. et al. Randomised trial of estimating oral endotracheal tube insertion depth in newborns using weight or vocal cord guide. Arch Dis Child Fetal Neonatal Ed 2018; 103 (04) F312-F316
11 Shukla HK, Hendricks-Munoz KD, Atakent Y, Rapaport S. Rapid estimation of insertional length of endotracheal intubation in newborn infants. J Pediatr 1997; 131 (04) 561-564
12 Wang TC, Kuo LL, Lee CY. Utilizing nasal-tragus length to estimate optimal endotracheal tube depth for neonates in Taiwan. Indian J Pediatr 2011; 78 (03) 296-300
13 Tatwavedi D, Nesargi SV, Shankar N, Mathias P, Rao Pn S. Efficacy of modified Tochen's formula for optimum endotracheal tube placement in low birth weight neonates: an RCT. J Perinatol 2018; 38 (05) 512-516
14 Gray MM, Delaney H, Umoren R, Strandjord TP, Sawyer T. Accuracy of the nasal-tragus length measurement for correct endotracheal tube placement in a cohort of neonatal resuscitation simulators. J Perinatol 2017; 37 (08) 975-978
15 Gul A, Takci S, Ince DA, Unuvar S. Assessment of endotracheal tube position after oral intubation in neonates. J Pediatr Res 2018; 5 (02) 71-75
16 Foglia EE, Ades A, Sawyer T. et al; NEAR4NEOS Investigators. Neonatal intubation practice and outcomes: an international registry study. Pediatrics 2019; 143 (01) e20180902