Download PDF
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 
1   Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
,
Mehmet Yekta Öncel 
2   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Izmir Katip Çelebi University, Izmir, Turkey
,
Gülsüm Kadıoğlu Şimşek
3   Clinic of Neonatology, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
,
Nilüfer Okur
4   Clinic of Neonatology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
,
Kıymet Çelik
4   Clinic of Neonatology, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
,
Özlem Bozkurt 
5   Clinic of Neonatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
,
Ebru Yücesoy
5   Clinic of Neonatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
,
Demet Terek
6   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
,
Meltem Koyuncu Arslan
1   Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
,
Yeliz Pekçevik
7   Department of Radiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
,
Melek Akar
1   Division of Neonatology, Department of Pediatrics, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
,
Özge Altun Köroğlu
6   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
,
Suna Oğuz
3   Clinic of Neonatology, Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey
,
Nilgün Kültürsay
6   Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

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

Note

This study was accepted as a poster presentation at the 34th International Workshop on Surfactant Replacement, SPIN, Parma, Italy, June 7–8, 2019.




Publication History

Received: 24 June 2019

Accepted: 19 October 2019

Article published online:
13 December 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Tochen ML. Orotracheal intubation in the newborn infant: a method for determining depth of tube insertion. J Pediatr 1979; 95 (06) 1050-1051
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 6 Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation 2008; 77 (03) 369-373
    CrossrefPubMedGoogle Scholar
  • 7 Sawyer T, Umoren RA, Gray MM. Neonatal resuscitation: advances in training and practice. Adv Med Educ Pract 2016; 8: 11-19
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar