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Optimal Positioning of Endotracheal Tubes for Ventilation of Preterm Infants
Avi Rotschild, MD;
David Chitayat, MD;
Martin L. Puterman, PhD;
Min S. Phang;
Emily Ling, MB, BS;
Virginia Baldwin, MD
Am J Dis Child. 1991;145(9):1007-1012.
Abstract
• Accurate knowledge of upper-airway dimensions is required to prevent malpositioning of endotracheal tubes in preterm infants. We measured vocal cord—carina, oralcarina, and nasal-carina distances in situ at autopsy of two groups of infants (<1000 and  1000 g). In all 24 infants, crown-heel length, crown-rump length, and occipitofrontal circumference were better than weight in predicting upper-airway dimensions. Flexion of the neck decreased and extension increased both nasal-carina and oral-carina distances. Lateral rotation produced no significant changes. The postmortem data were not different from nasal-carina distances measured radiologically in 40 living, nasally intubated and ventilated infants, confirming the clinical validity of our findings. Regression equations were derived to predict optimal endotracheal tube lengths based on the external measurements of crown-rump length and crown-heel length.
(AJDC. 1991;145:1007-1012)
Author Affiliations
From the Division of Neonatology, Departments of Pediatrics (Drs Rotschild, Phang, and Ling) and Medical Genetics (Dr Chitayat), Faculty of Commerce (Dr Puterman), and Department of Pathology (Dr Baldwin), University of British Columbia, B.C.'s Children's Hospital, Vancouver.
Footnotes
Accepted for publication February 25, 1991.
Read in part before the Joint Scientific Meeting of the Australian College of Paediatrics and the Singapore Paediatric Society with the Canadian Paediatric Society, Singapore, May 18, 1990; and presented as a poster exhibit at the American Academy of Pediatrics District VIII Perinatal Pediatrics Conference, Keystone, Colo, May 25 to 27, 1990.
Reprint requests to B.C.'s Children's Hospital, Room 1N1, 4480 Oak St, Vancouver, British Columbia, Canada V6H 3V4 (Dr Ling).
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