Optimal positioning of endotracheal tubes for ventilation of preterm infants
A. Rotschild, D. Chitayat, M. L. Puterman, M. S. Phang, E. Ling and V. Baldwin
Department of Pediatrics, University of British Columbia, B.C.'s Children's Hospital, Vancouver, Canada.
Accurate knowledge of upper-airway dimensions is required to prevent
malpositioning of endotracheal tubes in preterm infants. We measured vocal
cord-carina, oral-carina, and nasal-carina distances in situ at autopsy of
two groups of infants (less than 1000 and greater than or equal to 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.
