Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.021
Brazilian Journal of Anesthesiology
Clinical Research

Comparison of four formulas for nasotracheal tube length estimation in pediatric patients: an observational study

Ashkan Taghizadeh Imani, Mehrdad Goudarzi, Niloufar Shababi, Behrang Nooralishahi, Alireza Mohseni

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Abstract

Background
Correct endotracheal intubation results in better ventilation, prevents hypoxia and its possible damages, such as brain injury, and minimizes attempts for re-intubation. Up to now, several formulas have been published to estimate nasotracheal intubation tube length. This study aims to compare the accuracy of different suggested formulas to find the one that better estimates the tube insertion distance.

Methods
This cross-sectional retrospective study was carried out in 102 (51 female, 51 male) children who underwent cardiac surgery under general anesthesia. Inclusion criteria were correct nasotracheal intubation according to the postintubation chest X-ray (CXR). The estimated tracheal tube length was calculated by four different formulas. Pearson’s correlation coefficient was used to find the correlations between the estimated length of each formula and the correct nasotracheal tube length. Also, linear regression was used to obtain a formula to estimate nasotracheal tube length by weight, height, and age.

Results
The formula L = 3*tube size+2 had the best correlation with tube length (r = 0.81, confidence Interval: 0.732–0.878, p-value < 0.001). Among demographic variables, height had the highest correlation coefficient with the tube length (r = 0.83, confidence Interval: 0.788–0.802, p-value < 0.001). Therefore, considering the height as an independent variable and tube length as a dependent variable, using linear regression, the following formula was achieved for determining tube length: Nasotracheal tube length = 0.1*Height+7.

Conclusions
The formula L = 3*tube size+2 and the new suggested formula in this study can be used to estimate nasotracheal tube length in children under 4 years old. However, these formulas are only guides and require confirmation by auscultation and CXR.

Keywords

Intubation,  Intratracheal,  Pediatric,  Infant,  Child,  Anesthesia

References

1 R. Luten Accurate endotracheal tube placement in children: depth of insertion is part of a process Pediatr Crit Care Med., 6 (2005), pp. 606-608

2 S.F. Khatami, P. Parvaresh, S. Behjati Common complications of endotracheal intubation in newborns Iran J Neonatol IJN., 2 (2011), pp. 12-17

3 J. Divatia, K. Bhowmick Complications of endotracheal intubation and other airway management procedures Indian J Anaesth., 49 (2005), pp. 308-318

4 F.H. Levy, S.L. Bratton, D.S. Jardine Routine chest radiographs following repositioning of endotracheal tubes are necessary to assess correct position in pediatric patients Chest., 106 (1994), pp. 1508-1510

5 R. Niwas, A.M. Nadroo, V.G. Sutija, et al. Malposition of endotracheal tube: association with pneumothorax in ventilated neonates Arch Dis Child Fetal Neonatal Ed., 92 (2007), pp. F233-4

6 P. Mainie, A. Carmichael, S. McCullough, et al. Endotracheal tube position in neonates requiring emergency interhospital transfer Am J Perinatol., 23 (2006), pp. 121-124

7 P.K. Gupta, P.K. Gupta, M. Jain, et al. Postprocedural chest radiograph: impact on the management in critical care unit Anesth Essays Res., 8 (2014), pp. 139-144

8 J.H. Pek, E.M. Tan, Y. Hao, et al. Comparison of formulae for orotracheal intubation depth in the paediatric population Ann Acad Med Singapore., 47 (2018), pp. 138-142

9 M. Boensch, V. Schick, O. Spelten, et al. Estimation of the optimal tube length: systematic review article on published formulae for infants and children Anaesthesist., 65 (2016), pp. 115-121

10 M. Kemper, A. Dullenkopf, A.R. Schmidt, et al. Nasotracheal intubation depth in paediatric patients Br J Anaesth., 113 (2014), pp. 840-846

11 M.C. Murphy, V.B. Donoghue, C.P.F. O’Donnell Randomised trial of estimating oral endotracheal tube insertion depth in newborns using suprasternal palpation of the tip or weight Arch Dis Child Fetal Neonatal Ed., 105 (2020), pp. 196-200

12 N.H. Greene, E.H. Jooste, D.P. Thibault, et al. A study of practice behavior for endotracheal intubation site for children with congenital heart disease undergoing surgery: impact of endotracheal intubation site on perioperative outcomes-an analysis of the society of thoracic surgeons congenital cardiac anesthesia society database Anesth Analg., 129 (2019), pp. 1061-1068

13 B.M. Moore, K. Blumberg, T.A. Laguna, et al. Incidental sinusitis in a pediatric intensive care unit Pediatr Crit Care Med., 13 (2012), pp. e64-8

14 H.K. Shukla, K.D. Hendricks-Munoz, Y. Atakent, et al. Rapid estimation of insertional length of endotracheal intubation in newborn infants J Pediatr., 131 (1997), pp. 561-564

15 G.J. Hauser, E. Muir, L.M. Kline, et al. Prospective evaluation of a nonradiographic device for determination of endotracheal tube position in children Crit Care Med., 18 (1990), pp. 760-763

16 S. Antona M de la, J. López-Herce, M. Rupérez, et al. Estimation of the length of nasotracheal tube to be introduced in children J Pediatr., 140 (2002), pp. 772-774

17 N. Lau, S.D. Playfor, A. Rashid, et al. New formulae for predicting tracheal tube length Paediatr Anaesth., 16 (2006), pp. 1238-1243

18 MP Blayney, DR Logan First thoracic vertebral body as reference for endotracheal tube placement Arch Dis Child Fetal Neonatal Ed., 71 (1994), pp. F32-5

19 T. Koshy, S. Misra, N. Chatterjee, et al. Accuracy of a chest X-Ray-based method for predicting the depth of insertion of endotracheal tubes in pediatric patients undergoing cardiac surgery J Cardiothorac Vasc Anesth., 30 (2016), pp. 947-953

20 A.P. Yates, A.J. Harries, D.J. Hatch Estimation of nasotracheal tube length in infants and children Br J Anaesthesia England., 59 (1987), pp. 524-526

21 S.B. Hulley, S.R. Cummings, W.S. Browner, et al. Designing clinical research: an epidemiologic approach (4th ed.), Lippincott Williams & Wilkins, Philadelphia, PA (2013), p. 79 Appendix 6C

22 M. Weiss, C. Balmer, A. Dullenkopf, et al. Intubation depth markings allow an improved positioning of endotracheal tubes in children Can J Anaesth., 52 (2005), pp. 721-726

23 HT Davenport Paediatric Anaesthesia (3rd Edn.), Heinemann Medical Books, London (1980)

24 DA Levine Normal Growth KJ Marcdante, RM Kliegman (Eds.), Nelson Essentials of Pediatrics, Elsevier Saunders, Philadelphia (2015), pp. 10-12
 

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