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Intubation depth markings allow an improved positioning of endotracheal tubes in children

[Le marquage de la profondeur d’insertion permet d’améliorer la mise en place de tubes endotrachéaux chez les enfants]

Markus Weiss, MD^*, Christian Balmer, MD, Alexander Dullenkopf, MD^*, Walter Knirsch, MD, Andreas Ch. Gerber, MD^*, Urs Bauersfeld, MD and Felix Berger, MD^,

^* From the Department of Anesthesia and
the Division of Congenital Heart Disease, University Children’s Hospital, Zurich, Switzerland; and
the Department of Congenital Heart Disease, German Heart Institute Berlin and Charite-Universitätsmedizin Berlin, Berlin, Germany.

Address correspondence to: Dr. Markus Weiss, Department of Anesthesia, University Children’s Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland. Phone: +41 44 266 71 11; Fax: +41 44 266 79 94; E-mail: markus.weiss{at}kispi.unizh.ch

Objectives: To evaluate the position of the new Microcuff® pediatric tracheal tube, based upon intubation depth markings.

Methods: With Institutional Ethics Committee approval and informed parental consent, we included patients from birth ( 3 kg) to 16 yr undergoing interventional cardiac catheterization requiring general anesthesia with orotracheal intubation. The intubation depth mark of the tracheal tube was placed between the vocal cords by direct laryngoscopy. The distance between tube tip and tracheal carina was measured from routinely taken cardiac catheterization posterior-anterior x-ray computer images with the patient supine and the head in a neutral position. Evaluation was performed for 20 tubes size 3.0 mm internal diameter (ID) and for ten tubes of each size from 3.5 to 7.0 mm ID.

Results: 100 patients were studied (47 girls; 53 boys). Tracheal tube tip advancement into the trachea ranged from 40.6% to 68.6% (median 51.4%). The shortest distance from tube tip to the tracheal carina was 15.7 mm using a 3.0 mm ID tube. Using a standard formula for tube insertion in children aged two years [12 cm + (age/2)], in one patient the tube tip would have been below the carina and in seven patients the tube cuffs would have been placed within the larynx.

Conclusions: The intubation depth markings of the new Microcuff® pediatric tracheal tube allow safe placement of the tracheal tube with a cuff-free laryngeal zone without the risk for endobronchial intubation. Placement using the intubation depth markings was superior to predicted insertion using a standard formula.

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