A new formula based on height for determining endotracheal intubation depth in pediatrics: A prospective study

• Published in: Journal of clinical anesthesia Vol. 86; p. 111079
• Main Authors: Zhuang, Pei-Er, Lu, Jiang-Hong, Wang, Wei-Kai, Cheng, Ming-Hua
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2023; Elsevier Limited
• Subjects: Age; Airway; Anesthesia; Anesthesia, General; Child; Child, Preschool; Correlation analysis; Endotracheal intubation; Extubation; Gender; Height; Humans; Intubation; Intubation depth; Intubation, Intratracheal; Nose; Pain Medicine; Pediatric; Pediatrics; Prospective Studies; Regression analysis; Statistical analysis; Trachea; Intubation depth; Height; Airway; Pediatric; Endotracheal intubation
• DOI: 10.1016/j.jclinane.2023.111079
• ISSN: 0952-8180; 1873-4529

The main objective was to devise an endotracheal intubation formula based on pediatric patients' strongly correlated growth parameters. The secondary objective was to compare the accuracy of the new formula to the age-based formula from Advanced Pediatric Life Support Course (APLS formula) and the middle finger length-based formula (MFL-based formula). A prospective, observational study. Operation. 111 subjects age 4–12 years old undergoing elective surgeries with general orotracheal anesthesia. Growth parameters, including age, gender, height, weight, BMI, middle finger length, nasal-tragus length, and sternum length, were measured before surgeries. Tracheal length and the optimal endotracheal intubation depth (D) were measured and calculated by Disposcope. Regression analysis were used to establish a new formula for predicting the intubation depth. A self-controlled paired design was used to compare the accuracy of the intubation depth between the new formula, APLS formula, and MFL-based formula. Height (R = 0.897, P < 0.001) was strongly correlated to tracheal length and the endotracheal intubation depth in pediatric patients. New formulae basing on height were established, including new formula 1: D (cm) = 4 + 0.1 × Height (cm) and new formula 2: D (cm) = 3 + 0.1 × Height (cm). Via Bland-Altman analysis, the mean differences for new formula 1, new formula 2, APLS formula and MFL-based formula were − 0.354 cm (95% LOA, −1.289 to 1.998 cm), 1.354 cm (95% LOA, −0.289 to 2.998 cm), 1.154 cm (95% LOA, −1.002 to 3.311 cm), −0.619 cm (95% LOA, −2.960 to 1.723 cm), respectively. The rate of optimal intubation for new formula 1 (84.69%) was higher than for new formula 2 (55.86%), APLS formula (61.26%), and MFL-based formula. (69.37%). The prediction accuracy for intubation depth of the new formula 1 was higher than the other formulae. The new formula based on height: D (cm) = 4 + 0.1 × Height (cm) was preferable to APLS formula and MFL-based formula with a high incidence of appropriate endotracheal tube position. •Endotracheal intubation depth was individualized in pediatric patients.•Body height was strongly correlated with endotracheal intubation depth.•The adoption of the height-based formula decreased the incidence of endotracheal tube malposition.•The new formula based on height provided a rapid and convenient method to predict intubation depth.